Provider Demographics
NPI:1831625029
Name:COLLINS SMITH, SOPHIA (LPN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:COLLINS SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 PROVIDENCE DR
Mailing Address - Street 2:APT 818
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3652
Mailing Address - Country:US
Mailing Address - Phone:248-242-0522
Mailing Address - Fax:
Practice Address - Street 1:23300 PROVIDENCE DR
Practice Address - Street 2:APT 818
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3652
Practice Address - Country:US
Practice Address - Phone:248-242-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703111821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse