Healthcare Provider Details

I. General information

NPI: 1174533202
Provider Name (Legal Business Name): MIMI SUE SMITH-DANIELSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26788 HIGHLAND RD NE
KINGSTON WA
98346
US

IV. Provider business mailing address

26788 HIGHLAND RD NE
KINGSTON WA
98346
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-8876
  • Fax: 360-297-0777
Mailing address:
  • Phone: 360-297-8876
  • Fax: 360-297-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00039969
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30001519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: