Healthcare Provider Details

I. General information

NPI: 1942636410
Provider Name (Legal Business Name): MS. CHRISTINE ANN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41810 N VENTURE DR UNIT E160
ANTHEM AZ
85086-3177
US

IV. Provider business mailing address

41810 N VENTURE DR UNIT E160
ANTHEM AZ
85086-3177
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-0025
  • Fax: 623-266-3053
Mailing address:
  • Phone: 623-233-0025
  • Fax: 623-266-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4921
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: