Individual
MATTHEW L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1060 CERRILLOS RD, SANTA FE, NM 87505-1650
(505) 476-6410
Mailing address
1060 CERRILLOS RD, SANTA FE, NM 87505-1650
(505) 476-6410
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R26377
NM
163WS0200X
School Registered Nurse
291816
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36672548
—
NM
Enumeration date
10/29/2018
Last updated
06/10/2019
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