Healthcare Provider Details

I. General information

NPI: 1326249301
Provider Name (Legal Business Name): JENNIFER DELOZIER SMITH NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY DEPT. OF MATERNAL CHILD NURSING
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

700 LAWRENCE EXPY DEPT. OF MATERNAL CHILD NURSING
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 831-251-6975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16155
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number2382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: