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NPI Code Detail

MEDICARE: CONNOR SMITH

MEDICARE: CONNOR SMITH
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1649138306
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR SMITH
Provider Business Mailing Address
First Line : 9918 79TH DR NE
Second Line :
City : MARYSVILLE
State : WA
Zip : 98270-7943
Country : US
Telephone Number : 425-293-2177
Fax Number :
Provider Business Practice Location Address
First Line : 7101 JAHNKE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23225-4017
Country : US
Telephone Number : 425-293-2177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “ CONNOR SMITH ” Practice Location

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