Healthcare Provider Details

I. General information

NPI: 1447997788
Provider Name (Legal Business Name): GAIL ELIZABETH SMITH RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 RUCKER AVE
EVERETT WA
98201-2019
US

IV. Provider business mailing address

1717 RUCKER AVE
EVERETT WA
98201-2019
US

V. Phone/Fax

Practice location:
  • Phone: 425-422-3650
  • Fax:
Mailing address:
  • Phone: 425-422-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN0005808
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: