1720152119 NPI number — MS. VICKI LYNN NELSON SMEBY MA LLP

Table of content: MS. VICKI LYNN NELSON SMEBY MA LLP (NPI 1720152119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720152119 NPI number — MS. VICKI LYNN NELSON SMEBY MA LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMEBY
Provider First Name:
VICKI
Provider Middle Name:
LYNN NELSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMEBY
Provider Other First Name:
VICKI
Provider Other Middle Name:
NELSON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA LLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720152119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2208 STRATFORD CT SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49506-4133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-460-1819
Provider Business Mailing Address Fax Number:
616-942-9490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4519 CASCADE RD SE
Provider Second Line Business Practice Location Address:
BLDG 2 STE 1
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-460-1819
Provider Business Practice Location Address Fax Number:
616-942-9490
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  6301010861 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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