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General NPI Number Information
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NPI Number | 1194929950
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Entity Type | Individual
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Provider Name | MS. DEBORAH SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1008 BETHEL AVE STE A
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City | PORT ORCHARD
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State | WA
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Zip | 98366-4236
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Country | US
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Telephone | 360-509-3774
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Fax |
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Provider Business Mailing Address
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Address Line | 412 SW LOTUS CT
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City | PORT ORCHARD
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State | WA
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Zip | 98367-7200
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Country | US
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Telephone | 360-874-9765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00012238
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License Number State | WA
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