MEDICARE: CATHY SMYSER FNP- C

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	363LP2300X	Primary Care Nurse Practitioner	RN066855	AZ
2	363LF0000X	Family Nurse Practitioner	066855	AZ

General Provider Information

NPI Number	:	1467405167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY SMYSER FNP- C

Provider Business Mailing Address
First Line	:	20340 N LAKE PLEASANT RD
Second Line	:	STE 109
City	:	PEORIA
State	:	AZ
Zip	:	85382-9713
Country	:	US
Telephone Number	:	623-334-4000
Fax Number	:	623-334-4400

Provider Business Practice Location Address
First Line	:	7200 W BELL RD
Second Line	:	A-1
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8529
Country	:	US
Telephone Number	:	623-334-4000
Fax Number	:	623-334-4400

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/06/2020

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