Healthcare Provider Details

I. General information

NPI: 1811809007
Provider Name (Legal Business Name): HEATHER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W NORTH BEND WAY
NORTH BEND WA
98045-8163
US

IV. Provider business mailing address

7514 PINNACLE PL SE
SNOQUALMIE WA
98065-8981
US

V. Phone/Fax

Practice location:
  • Phone: 425-200-0130
  • Fax:
Mailing address:
  • Phone: 206-293-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: