Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP60803548 | WA |
NPI | 1336695311 |
---|---|
Provider Name | Misty L Smith |
First Address | Lacey, WA 98503 |
Second Address | Seattle, WA 98105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 17/03/2018 |