Healthcare Provider Details

I. General information

NPI: 1346941309
Provider Name (Legal Business Name): MS. MARCI LYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 TUNNEL ST
SANTA MARIA CA
93458
US

IV. Provider business mailing address

117 TUNNEL ST
SANTA MARIA CA
93458
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax:
Mailing address:
  • Phone: 805-614-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number319494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: