Healthcare Provider Details

I. General information

NPI: 1023368453
Provider Name (Legal Business Name): ANGELA BETH SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 MYRTLE AVE STE C
EUREKA CA
95501-1495
US

IV. Provider business mailing address

1651 MYRTLE AVE STE C
EUREKA CA
95501-1495
US

V. Phone/Fax

Practice location:
  • Phone: 707-599-6700
  • Fax: 888-475-8698
Mailing address:
  • Phone: 707-599-6700
  • Fax: 888-475-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number846580
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number23313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: