Healthcare Provider Details

I. General information

NPI: 1710732946
Provider Name (Legal Business Name): JENNIFER DENISE SMOLENS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BERTHA HOWE AVE STE 2
MESQUITE NV
89027-7503
US

IV. Provider business mailing address

1362 N VIA DEL SOL
WASHINGTON UT
84780-3617
US

V. Phone/Fax

Practice location:
  • Phone: 702-345-2122
  • Fax:
Mailing address:
  • Phone: 951-852-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number874621
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number874621
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: