Healthcare Provider Details

I. General information

NPI: 1457684110
Provider Name (Legal Business Name): MIYOSHI SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 86 MARKER 74 HC 01 SAN SIMON HEALTH CTR 8178
SELLS AZ
85634-9726
US

IV. Provider business mailing address

HC 1 BOX 8178 ATTN: SAN SIMON HEALTH CENTER US HIGHWAY 86
SELLS AZ
85634-9726
US

V. Phone/Fax

Practice location:
  • Phone: 520-362-7089
  • Fax: 520-362-7080
Mailing address:
  • Phone: 520-362-7089
  • Fax: 520-362-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4201
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: