Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 082010344N3 | OR |
NPI | 1003071176 |
---|---|
Provider Name | Patrick R Smart |
First Address | Walla Walla, WA 99362-3975 |
Second Address | Walla Walla, WA 99362-2846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 24/08/2015 |