Healthcare Provider Details

I. General information

NPI: 1982006821
Provider Name (Legal Business Name): MR. COURTNEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 E MADISON ST STE 200
SEATTLE WA
98112-4752
US

IV. Provider business mailing address

1600 E OLIVE ST
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2600
  • Fax: 206-302-2610
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2221

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: