Healthcare Provider Details

I. General information

NPI: 1255707675
Provider Name (Legal Business Name): CHANCE E SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date: 12/10/2021
Reactivation Date: 09/08/2023

III. Provider practice location address

330 S GARDEN WAY
EUGENE OR
97401-8176
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-6816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10063733
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: