Healthcare Provider Details

I. General information

NPI: 1851576334
Provider Name (Legal Business Name): NANCY LYNN SMITH RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 E TICONDEROGA DR
FRESNO CA
93720-4218
US

IV. Provider business mailing address

1745 E TICONDEROGA DR
FRESNO CA
93720-4218
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-5481
  • Fax: 559-433-9641
Mailing address:
  • Phone: 559-977-9457
  • Fax: 559-433-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberCNS2216
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN236438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: