1144228198 NPI number — MRS. PATRICIA ANNE SMITH NURSE PRACTITIONER

Table of content: MRS. PATRICIA ANNE SMITH NURSE PRACTITIONER (NPI 1144228198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144228198 NPI number — MRS. PATRICIA ANNE SMITH NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
PATRICIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALLE
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144228198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 SULLIVAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78213-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-337-4233
Provider Business Mailing Address Fax Number:
210-337-4799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 GOLIAD RD
Provider Second Line Business Practice Location Address:
SUITE #125
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78223-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-337-4233
Provider Business Practice Location Address Fax Number:
210-337-4210
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  564579 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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