Healthcare Provider Details

I. General information

NPI: 1336445998
Provider Name (Legal Business Name): WESLEY PAUL SMITH SFA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WESLEY PAUL SMITH SFA-C

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 TUSCANY CT.
HENDERSON NV
89074
US

IV. Provider business mailing address

308 TUSCANY CT
HENDERSON NV
89074-5941
US

V. Phone/Fax

Practice location:
  • Phone: 702-283-6196
  • Fax: 702-425-7480
Mailing address:
  • Phone: 702-283-6196
  • Fax: 702-425-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number00F536
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: