Basic Information
| Provider Information | |||||||||
| NPI: | 1699482901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMILANSKY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | HANNAH | ||||||||
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| Credential: | MSN, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 RIVERBEND DR | ||||||||
| Address2: | |||||||||
| City: | PEGRAM | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371432360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484211059 | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 E EH CRUMP BLVD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381265394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012612000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 32838 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.