Basic Information
| Provider Information | |||||||||
| NPI: | 1720553860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | SABINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 HYDE PARK DR | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757582033 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1828 ESE LOOP323 STE 101 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757018314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037301419 | ||||||||
| FaxNumber: | 8777993230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2018 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 567330 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.