Healthcare Provider Details

I. General information

NPI: 1710355433
Provider Name (Legal Business Name): D. LAURIE SMITH-HAUGEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOROTHEA SMITH-HAUGEN NP

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 MERCY CT STE B
FAIR OAKS CA
95628-3171
US

IV. Provider business mailing address

6608 MERCY CT STE B
FAIR OAKS CA
95628-3171
US

V. Phone/Fax

Practice location:
  • Phone: 916-277-8881
  • Fax: 916-244-8176
Mailing address:
  • Phone: 916-277-8881
  • Fax: 916-244-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95039268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95047481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: