Provider Demographics
NPI:1285092841
Name:SMART, CATHERINE REGINA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:REGINA
Last Name:SMART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:REGINA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10650 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9370
Mailing Address - Country:US
Mailing Address - Phone:734-915-0856
Mailing Address - Fax:734-682-5083
Practice Address - Street 1:1066 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3113
Practice Address - Country:US
Practice Address - Phone:734-240-4870
Practice Address - Fax:734-682-5083
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily