Healthcare Provider Details

I. General information

NPI: 1003036757
Provider Name (Legal Business Name): CYNTHIA JEAN SMITH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 3RD AVE
JUNCTION CITY OR
97448-1313
US

IV. Provider business mailing address

1292 HIGH ST STE 224
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-7625
  • Fax:
Mailing address:
  • Phone: 541-500-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number095006901N3
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: