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NPI Code Detail

MEDICARE: ANNISSA SMITH RN

MEDICARE: ANNISSA SMITH RN
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
1163W00000XRegistered Nurse201240125RNOR

General Provider Information

NPI Number : 1689538803
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNISSA SMITH RN
Provider Business Mailing Address
First Line : 5393 SW DOVER CT
Second Line :
City : PORTLAND
State : OR
Zip : 97225-1013
Country : US
Telephone Number : 503-257-1732
Fax Number :
Provider Business Practice Location Address
First Line : 11611 NE AINSWORTH CIR
Second Line :
City : PORTLAND
State : OR
Zip : 97220-9017
Country : US
Telephone Number : 503-257-1732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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