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General NPI Number Information
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NPI Number | 1508250580
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Entity Type | Individual
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Provider Name | DIANE SMITH APRN, FNP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 10648 S REMBRANDT LN
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City | SANDY
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State | UT
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Zip | 84070-5224
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Country | US
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Telephone | 435-313-3142
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Fax | 801-705-0118
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Provider Business Mailing Address
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Address Line | 1301 BERTHA HOWE AVE SUITE 1
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City | MESQUITE
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State | NV
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Zip | 89027-7502
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Country | US
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Telephone | 702-346-0800
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Fax | 702-346-0801
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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 | APRN001916
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 8775403-4405
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License Number State | UT
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