MEDICARE: ABIGAIL 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
1	163WH0200X	Home Health Registered Nurse	276909	AZ

General Provider Information

NPI Number	:	1790502987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL SMITH RN

Provider Business Mailing Address
First Line	:	3202 W EAGLE CLAW DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-2233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 W EAGLE CLAW DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-2233
Country	:	US
Telephone Number	:	916-878-6541
Fax Number	:

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

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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