Healthcare Provider Details

I. General information

NPI: 1548643349
Provider Name (Legal Business Name): GEANNINE SMITH REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILLOW PASS RD STE 100
CONCORD CA
94520-7946
US

IV. Provider business mailing address

1430 WILLOW PASS RD STE 100
CONCORD CA
94520-7946
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3906
  • Fax:
Mailing address:
  • Phone: 925-288-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95045222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: