Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003461963 |
---|---|
Provider Name | Jami Smith |
First Address | Farmington, NM 87401-5527 |
Second Address | Farmington, NM 87401-5518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 07/08/2019 |