Individual
SHANE RICHARD SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1650 COWLES ST, FAIRBANKS, AK 99701-5907
(907) 452-8181
Mailing address
2 N 3000 E, SUGAR CITY, ID 83448-1220
(360) 600-7852
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
145179
AK
Other
Enumeration date
10/05/2022
Last updated
10/05/2022
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