Healthcare Provider Details

I. General information

NPI: 1790522696
Provider Name (Legal Business Name): CECILIA MARIE SMITH MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 E JEWELL AVE STE 500
DENVER CO
80222-4509
US

IV. Provider business mailing address

9444 W HINSDALE PL
LITTLETON CO
80128-4168
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-2773
  • Fax:
Mailing address:
  • Phone: 720-231-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999930
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: