Provider Demographics
NPI:1205690039
Name:SMITH, DENNIS DUANE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:DUANE
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E6187 STATE ROAD M28
Mailing Address - Street 2:
Mailing Address - City:AU TRAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49806-9665
Mailing Address - Country:US
Mailing Address - Phone:906-202-3154
Mailing Address - Fax:
Practice Address - Street 1:7870W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1599
Practice Address - Country:US
Practice Address - Phone:906-341-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily