Healthcare Provider Details

I. General information

NPI: 1336349729
Provider Name (Legal Business Name): JENNY SMOKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST C212, BOX 356340
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1200 MOUNTAINT STREET
CARSON CITY NV
89703
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-0069
  • Fax:
Mailing address:
  • Phone: 775-885-2229
  • Fax: 775-882-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML20008943
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: