Healthcare Provider Details

I. General information

NPI: 1386736205
Provider Name (Legal Business Name): JANET L SMITH CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST SUITE C
SANTA FE NM
87505-4780
US

IV. Provider business mailing address

1691 GALISTEO ST SUITE C
SANTA FE NM
87505-4780
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-5631
  • Fax: 505-982-5605
Mailing address:
  • Phone: 505-983-5631
  • Fax: 505-982-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR36862
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: