MEDICARE: MARYANN SMITH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	220455	AZ
2	363LA2100X	Acute Care Nurse Practitioner	220454	AZ

General Provider Information

NPI Number	:	1205394947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN SMITH NP

Provider Business Mailing Address
First Line	:	2327 W DEWDROP TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-0719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 W DEWDROP TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-0719
Country	:	US
Telephone Number	:	480-255-1641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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