Healthcare Provider Details

I. General information

NPI: 1639150964
Provider Name (Legal Business Name): NANCY L SMITH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W SOUTH BOULDER RD
LOUISVILLE CO
80027-2412
US

IV. Provider business mailing address

1504 SPRING CREEK DR
LAFAYETTE CO
80026-3437
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-7337
  • Fax: 303-666-7379
Mailing address:
  • Phone: 303-665-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number86057
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: