Healthcare Provider Details

I. General information

NPI: 1437983608
Provider Name (Legal Business Name): KATHLEEN RENEE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 PROFESSIONAL CIR STE 125
RENO NV
89521-3100
US

IV. Provider business mailing address

10345 PROFESSIONAL CIR STE 125
RENO NV
89521-3100
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-7300
  • Fax:
Mailing address:
  • Phone: 775-348-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95309
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: