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General NPI Number Information
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NPI Number | 1689167496
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Entity Type | Individual
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Provider Name | NICOLE SMITH RN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 931 NW VIEWPOINT PL
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City | HILLSBORO
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State | OR
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Zip | 97124-3725
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Country | US
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Telephone | 206-920-2409
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Fax |
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Provider Business Mailing Address
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Address Line | 14685 SW OSPREY DR APT 1123
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City | BEAVERTON
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State | OR
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Zip | 97007-7964
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Country | US
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Telephone | 206-920-2409
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 201608078RN
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License Number State | OR
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