Individual
DIANA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
419 E 7TH ST STE 207, THE DALLES, OR 97058-2676
(541) 296-5452
(541) 296-5048
Mailing address
419 E 7TH ST STE 207, THE DALLES, OR 97058-2676
(541) 296-5452
(541) 296-5048
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699745794
—
OR
Enumeration date
08/30/2016
Last updated
08/30/2016
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