Provider Demographics
NPI:1770398463
Name:SMITH, BRIANNA (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 W LOOMIS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8030
Mailing Address - Country:US
Mailing Address - Phone:414-488-1111
Mailing Address - Fax:
Practice Address - Street 1:10500 W LOOMIS RD STE 130
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8030
Practice Address - Country:US
Practice Address - Phone:414-488-1111
Practice Address - Fax:414-246-2197
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16477-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty