Provider Demographics
NPI:1588748164
Name:SMITH, MICHAEL CORDON (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CORDON
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 454 BOX 2322
Mailing Address - Street 2:
Mailing Address - City:APO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 454 BOX 2322
Practice Address - Street 2:
Practice Address - City:APO AE
Practice Address - State:BAVARIA
Practice Address - Zip Code:09250
Practice Address - Country:DE
Practice Address - Phone:0980-283-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX528684163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice