Provider Demographics
NPI:1790112936
Name:SMITH, LYNDSEY MARY (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:MARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:MARY
Other - Last Name:BOLLAERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE HURLEY PLAZA
Mailing Address - Street 2:SON 5TH FLOOR
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-262-9353
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:ONE HURLEY PLAZA
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5993
Practice Address - Country:US
Practice Address - Phone:810-262-9967
Practice Address - Fax:810-262-9610
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704261112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered