Healthcare Provider Details

I. General information

NPI: 1184556649
Provider Name (Legal Business Name): JULIE ELIZABETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 114
PHOENIX AZ
85013-4420
US

IV. Provider business mailing address

1716 E WINDSONG DR
PHOENIX AZ
85048-9442
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-5416
  • Fax:
Mailing address:
  • Phone: 480-773-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN121885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: