Healthcare Provider Details

I. General information

NPI: 1467840579
Provider Name (Legal Business Name): ANISA CORINNE SMITH DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISA ASCARI

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4238
US

IV. Provider business mailing address

521 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4238
US

V. Phone/Fax

Practice location:
  • Phone: 253-792-6680
  • Fax:
Mailing address:
  • Phone: 253-792-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM2034
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60532676
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP60532676
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60532676
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP60532676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: