Healthcare Provider Details

I. General information

NPI: 1891745428
Provider Name (Legal Business Name): ROBERT G SMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 RENNER DR
FORTUNA CA
95540-3120
US

IV. Provider business mailing address

PO BOX 993
FERNDALE CA
95536-0993
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-6101
  • Fax: 707-725-2978
Mailing address:
  • Phone: 707-786-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN238330
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFNP877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: