Healthcare Provider Details

I. General information

NPI: 1184609893
Provider Name (Legal Business Name): JANIS LEIGH SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 STATE HIGHWAY 193
GEORGETOWN CA
95634-9623
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-333-2548
  • Fax: 530-748-0340
Mailing address:
  • Phone: 530-626-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF13247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: