Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | CNP-02988 | NM |
NPI | 1427419357 |
---|---|
Provider Name | Jenifer Smyer |
First Address | Deming, NM 88031-2563 |
Second Address | Tucson, AZ 85712-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2016 |
Last Update Date | 06/10/2016 |