Healthcare Provider Details

I. General information

NPI: 1164706677
Provider Name (Legal Business Name): PATRICIA SMITH R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490B W ZIA RD STE 1
SANTA FE NM
87505-7009
US

IV. Provider business mailing address

19420 N 59TH AVE STE B233
GLENDALE AZ
85308-6886
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-8346
  • Fax:
Mailing address:
  • Phone: 505-984-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR34622
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: