1750578407 NPI number — MRS. ROBERTA JEAN DISCHINGER-SMEDES MSN, APRN, BC, FNP

Table of content: MRS. ROBERTA JEAN DISCHINGER-SMEDES MSN, APRN, BC, FNP (NPI 1750578407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750578407 NPI number — MRS. ROBERTA JEAN DISCHINGER-SMEDES MSN, APRN, BC, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DISCHINGER-SMEDES
Provider First Name:
ROBERTA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, BC, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750578407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 INDUSTRIAL PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49013-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-427-7937
Provider Business Mailing Address Fax Number:
269-427-5180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 JAMES ST
Provider Second Line Business Practice Location Address:
INTERCARE COMMUNITY HEALTH NETWORK
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49424-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-218-3008
Provider Business Practice Location Address Fax Number:
606-399-5055
Provider Enumeration Date:
09/26/2007

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: 363LF0000X , with the licence number:  4704180107 , 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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