Healthcare Provider Details

I. General information

NPI: 1740247352
Provider Name (Legal Business Name): CHERYL L SMITH R.N., F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MEEKER ST
DELTA CO
81416-1920
US

IV. Provider business mailing address

555 MEEKER ST
DELTA CO
81416-1920
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-5777
  • Fax: 970-874-1631
Mailing address:
  • Phone: 970-874-5777
  • Fax: 970-874-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number98432
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: