Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 208738 | CA |
NPI | 1003056151 |
---|---|
Provider Name | Ms. Heather Ann Smith |
First Address | Campbell, CA 95008-1822 |
Second Address | Stanford, CA 94305-5826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2009 |
Last Update Date | 03/03/2009 |