Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704306664 | MI |
NPI | 1013671809 |
---|---|
Provider Name | Matthew Nathan Smith |
First Address | Cadillac, MI 49601-2379 |
Second Address | Cadillac, MI 49601-2379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 13/12/2021 |