MEDICARE: SHANA RAE SMITH FNP-BC

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	221317	AZ

General Provider Information

NPI Number	:	1437901790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA RAE SMITH FNP-BC

Provider Business Mailing Address
First Line	:	4505 E CHANDLER BLVD STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7688
Country	:	US
Telephone Number	:	480-961-2365
Fax Number	:	480-961-2382

Provider Business Practice Location Address
First Line	:	4530 E MUIRWOOD DR STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7693
Country	:	US
Telephone Number	:	480-961-2365
Fax Number	:	480-961-2382

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	05/06/2026

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Directions to “ SHANA RAE SMITH FNP-BC” Practice Location

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