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NPI Code Detail

MEDICARE: MR. BENJAMIN A SMITH

MEDICARE: MR. BENJAMIN A SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN60575277WA
2363LG0600XGerontology Nurse PractitionerAP61054509WA

General Provider Information

NPI Number : 1205461522
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN A SMITH
Provider Business Mailing Address
First Line : 1724 POINTE WOODWORTH DR NE
Second Line :
City : TACOMA
State : WA
Zip : 98422-3480
Country : US
Telephone Number : 253-517-5466
Fax Number :
Provider Business Practice Location Address
First Line : 100 WASHINGTON AVE S STE 900
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 866-492-5336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2020
Last Update Date : 11/12/2020

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Directions to “ MR. BENJAMIN A SMITH ” Practice Location

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