Healthcare Provider Details

I. General information

NPI: 1871069336
Provider Name (Legal Business Name): SARAH MARY SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MONITOR ST
WENATCHEE WA
98801-3534
US

IV. Provider business mailing address

19425 BUTCHER CREEK RD
LEAVENWORTH WA
98826-9238
US

V. Phone/Fax

Practice location:
  • Phone: 509-300-1221
  • Fax:
Mailing address:
  • Phone: 509-679-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60122959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: