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General NPI Number Information
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NPI Number | 1457626061
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Entity Type | Individual
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Provider Name | JULIE ANN SMITH-CLARK FNP
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Gender | Female
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 4020 W FLORIDA AVE
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City | HEMET
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State | CA
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Zip | 92545-5279
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Country | US
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Telephone | 951-925-9565
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Fax | 951-766-7621
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Provider Business Mailing Address
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Address Line | 23811 WASHINGTON AVENUE STE C110, #158
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City | MURRIETA
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State | CA
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Zip | 92562-2277
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Country | US
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Telephone | 951-925-9565
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Fax | 951-766-7621
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21632
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License Number State | CA
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