Healthcare Provider Details

I. General information

NPI: 1801845508
Provider Name (Legal Business Name): WILLIAM HARRISON SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 QUARTERHORSE TRL
PROSSER WA
99350-2500
US

IV. Provider business mailing address

1215 QUARTERHORSE TRL
PROSSER WA
99350-2500
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-2888
  • Fax: 509-786-2888
Mailing address:
  • Phone: 509-786-2888
  • Fax: 509-786-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00072776
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberAP30005324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: