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NPI Code Detail

MEDICARE: MRS. BONITA B SMITH N.P.-C.

MEDICARE: MRS. BONITA B SMITH N.P.-C.
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
1363L00000XNurse PractitionerF0510070AZ

General Provider Information

NPI Number : 1851691612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BONITA B SMITH N.P.-C.
Provider Business Mailing Address
First Line : 6859 E REMBRANDT AVE
Second Line : SUITE 117
City : MESA
State : AZ
Zip : 85212-3628
Country : US
Telephone Number : 480-632-1577
Fax Number : 480-632-1574
Provider Business Practice Location Address
First Line : 6859 E REMBRANDT AVE
Second Line : SUITE 117
City : MESA
State : AZ
Zip : 85212-3628
Country : US
Telephone Number : 480-632-1577
Fax Number : 480-632-1574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2010
Last Update Date : 10/27/2010

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