Provider Demographics
NPI:1336795038
Name:SMITH, CHERI E (MS, LRCP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LRCP
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LRCP
Mailing Address - Street 1:4701 N WHITE RD
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:MI
Mailing Address - Zip Code:49339-9655
Mailing Address - Country:US
Mailing Address - Phone:616-644-6485
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2278P3900X
WY1196227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Yes2278P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedNeonatal/PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP-10206325OtherOREGON HEALTH AUTHORITY/HEALTH LICENSING OFFICE
VA0117008028OtherRESPIRATORY THERAPIST
MI4401009506OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
WALR61034292OtherWASHINGTON STATE DEPARTMENT OF HEALTH