Individual
SUSAN CHRISTINE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
607 W MAIN ST, GRANGEVILLE, ID 83530-1345
(208) 983-9590
Mailing address
607 W MAIN ST, GRANGEVILLE, ID 83530-1345
(208) 983-8590
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
34969
ID
363L00000X
Nurse Practitioner
Primary
66063
ID
Other
Enumeration date
06/01/2020
Last updated
12/23/2020
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