Provider Demographics
NPI:1053924035
Name:SMITH, DANNI MICHELE (RN, CA/CP SANE)
Entity type:Individual
Prefix:
First Name:DANNI
Middle Name:MICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, CA/CP SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HOOT PLANT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-1505
Mailing Address - Country:US
Mailing Address - Phone:430-342-3206
Mailing Address - Fax:
Practice Address - Street 1:806 HOOT PLANT RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-1505
Practice Address - Country:US
Practice Address - Phone:430-342-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX832057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse