Healthcare Provider Details

I. General information

NPI: 1316036403
Provider Name (Legal Business Name): ANGELA L SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BENEDICT COURT
ROWLETT TX
75088
US

IV. Provider business mailing address

1717 BENEDICT COURT
ROWLETT TX
75088
US

V. Phone/Fax

Practice location:
  • Phone: 318-469-4470
  • Fax:
Mailing address:
  • Phone: 318-469-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number637818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: