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General NPI Number Information
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NPI Number | 1508552829
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Entity Type | Individual
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Provider Name | RACHAEL EVE SMITH PNP-PC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1620 S KIMBALL AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4547
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Country | US
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Telephone | 208-505-2950
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Fax | 208-505-2955
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NUR-APRN-LIC-214478
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2661878
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License Number State | ID
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