Healthcare Provider Details

I. General information

NPI: 1871067090
Provider Name (Legal Business Name): DANIELLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 E 8TH ST
PORT ANGELES WA
98362-6220
US

IV. Provider business mailing address

1793 13TH ST SE
SALEM OR
97302-2541
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-0760
  • Fax: 360-994-4975
Mailing address:
  • Phone: 503-362-8385
  • Fax: 503-362-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP.AP.61017572-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: