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NPI Code Detail

MEDICARE: MR. NATHAN M SMITH PMHNP

MEDICARE: MR. NATHAN M SMITH PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner201050105NPOR

General Provider Information

NPI Number : 1396056727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN M SMITH PMHNP
Provider Business Mailing Address
First Line : 3407 S CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4621
Country : US
Telephone Number : 503-962-0493
Fax Number : 971-351-7001
Provider Business Practice Location Address
First Line : 3407 S CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4621
Country : US
Telephone Number : 503-962-0493
Fax Number : 971-351-7001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2010
Last Update Date : 03/14/2025

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