MEDICARE: DANIEL SMITH FNP

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
1	363LF0000X	Family Nurse Practitioner	4790877-4405	UT

General Provider Information

NPI Number	:	1356950554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL SMITH FNP

Provider Business Mailing Address
First Line	:	527 N 30 W
Second Line	:
City	:	AMERICAN FORK
State	:	UT
Zip	:	84003-1621
Country	:	US
Telephone Number	:	801-882-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	5097 S 900 E STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-5725
Country	:	US
Telephone Number	:	801-414-8758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/24/2020

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