Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 095006901N3 | OR |
NPI | 1003036757 |
---|---|
Provider Name | Mrs. Cynthia Jean Smith |
First Address | Eugene, OR 97401-3238 |
Second Address | Junction City, OR 97448-1313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 24/01/2020 |