Healthcare Provider Details

I. General information

NPI: 1205111069
Provider Name (Legal Business Name): GENEVIEVE FAYE SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENEVIEVE FAYE WHITE

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E RIVER PARK PL W SUITE 104
FRESNO CA
93720-1562
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-320-0530
  • Fax: 559-320-0532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP60249848
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95003463
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95003463
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberNP95003463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: