Individual
MS. TINA I SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
3211 AUTUMN CHASE WAY NE APT 104, SALEM, OR 97305-1561
(971) 239-9675
Mailing address
3211 AUTUMN CHASE WAY NE APT 104, SALEM, OR 97305-1561
(971) 239-9675
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
OR
174400000X
Specialist
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
O5329
—
OR
Enumeration date
05/17/2013
Last updated
12/22/2015
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