Healthcare Provider Details

I. General information

NPI: 1114494705
Provider Name (Legal Business Name): DANIELLE SMESTAD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 200
KLAMATH FALLS OR
97601-1130
US

IV. Provider business mailing address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-8400
  • Fax: 541-274-8405
Mailing address:
  • Phone: 541-274-6311
  • Fax: 541-274-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6166
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202004346NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: