MEDICARE: ELIZABETH ANNE SMEDLEY FNP

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	363LF0000X	Family Nurse Practitioner	NP-1582A	ID
2	363LA2200X	Adult Health Nurse Practitioner	813544	NV

General Provider Information

NPI Number	:	1407230931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE SMEDLEY FNP

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 E CACTUS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7722
Country	:	US
Telephone Number	:	702-877-0114
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	11/17/2025

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