1457684110 NPI number — MIYOSHI SMITH APRN

Table of content: MIYOSHI SMITH APRN (NPI 1457684110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457684110 NPI number — MIYOSHI SMITH APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MIYOSHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457684110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 8178
Provider Second Line Business Mailing Address:
ATTN: SAN SIMON HEALTH CENTER US HIGHWAY 86
Provider Business Mailing Address City Name:
SELLS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85634-9726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-362-7089
Provider Business Mailing Address Fax Number:
520-362-7080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US HWY 86 MARKER 74 HC 01
Provider Second Line Business Practice Location Address:
SAN SIMON HEALTH CTR 8178
Provider Business Practice Location Address City Name:
SELLS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85634-9726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-362-7089
Provider Business Practice Location Address Fax Number:
520-362-7080
Provider Enumeration Date:
09/14/2009

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:  AP4201 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004236346 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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