Healthcare Provider Details

I. General information

NPI: 1700175437
Provider Name (Legal Business Name): GINGER DOREEN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINGER DOREEN HALL

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-671-3225
  • Fax: 360-671-0000
Mailing address:
  • Phone: 206-764-3335
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30001750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: