Provider Demographics
NPI:1972802775
Name:SMITH, BARBARA
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:651 S 63RD ST APT 1
Mailing Address - Street 2:651 S 63 ST APT1
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1858
Mailing Address - Country:US
Mailing Address - Phone:414-763-3745
Mailing Address - Fax:
Practice Address - Street 1:651 S 63 ST
Practice Address - Street 2:APT1
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-763-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30270-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse