Healthcare Provider Details

I. General information

NPI: 1891207197
Provider Name (Legal Business Name): MARNIE MICHELLE SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 E 57TH AVE STE 27
SPOKANE WA
99223-7036
US

IV. Provider business mailing address

3016 E 57TH AVE STE 27
SPOKANE WA
99223-7036
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax: 509-755-6580
Mailing address:
  • Phone: 509-838-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number60430661
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60799338
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60799338
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: