Healthcare Provider Details

I. General information

NPI: 1710848171
Provider Name (Legal Business Name): RYAN THOMAS SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 12TH AVE APT 303
SEATTLE WA
98122-3311
US

V. Phone/Fax

Practice location:
  • Phone: 800-329-8387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61348586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: