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General NPI Number Information
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NPI Number | 1417931395
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Entity Type | Individual
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Provider Name | MARGUERITE JEAN SMITH ANP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2005
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 33 N CENTRAL AVE SUITE 425
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City | MEDFORD
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State | OR
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Zip | 97501-5900
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Country | US
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Telephone | 541-779-5877
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Fax | 541-664-3287
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Provider Business Mailing Address
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Address Line | PO BOX 965
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City | MEDFORD
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State | OR
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Zip | 97501-0069
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Country | US
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Telephone | 541-779-5877
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Fax | 541-664-3287
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 79042695
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License Number State | OR
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