Basic Information
| Provider Information | |||||||||
| NPI: | 1336795038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CHERI | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MS, LRCP | ||||||||
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| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | CHERI | ||||||||
| OtherMiddleName: | E | ||||||||
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| OtherCredential: | MS, LRCP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4701 N WHITE RD | ||||||||
| Address2: | |||||||||
| City: | PIERSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493399655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166446485 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MICHIGAN ST NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163919000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2278P3900X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Neonatal/Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P-10206325 | 01 | OR | OREGON HEALTH AUTHORITY/HEALTH LICENSING OFFICE | OTHER | 0117008028 | 01 | VA | RESPIRATORY THERAPIST | OTHER | 4401009506 | 01 | MI | MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS | OTHER | LR61034292 | 01 | WA | WASHINGTON STATE DEPARTMENT OF HEALTH | OTHER |