Provider Demographics
NPI:1871656629
Name:SMITH, SYLVIA LOU (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:LOU
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8584 LITTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2557
Mailing Address - Country:US
Mailing Address - Phone:313-934-1175
Mailing Address - Fax:
Practice Address - Street 1:8820 WOODROW WILSON ST
Practice Address - Street 2:HUTCHINS HEALTH CENTER (HENRY FORD HEALTH SYSTEM)
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2216
Practice Address - Country:US
Practice Address - Phone:313-873-1400
Practice Address - Fax:313-873-4735
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704079417363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4662828Medicaid