MEDICARE: DR. JENNIFER LYNN SMITH NMD

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	175F00000X	Naturopath	13-1375	AZ

General Provider Information

NPI Number	:	1407284441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN SMITH NMD

Provider Business Mailing Address
First Line	:	3841 E MONTE CRISTO AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4034
Country	:	US
Telephone Number	:	480-529-7348
Fax Number	:

Provider Business Practice Location Address
First Line	:	16421 N TATUM BLVD STE 210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-675-0170
Fax Number	:	602-675-1735

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

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	02/03/2020

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