Individual
BETTY C SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNFA
Contact information
Practice address
3735 N. TABOR STREET, MESA, AZ 85215
(480) 699-0155
(480) 699-0155
Mailing address
3735 N. TABOR STREET, MESA, AZ 85215
(480) 699-0155
(480) 699-0155
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
RN 058867
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z5564
HEALTNET OF AZ
AZ
05
—
359861
—
AZ
01
—
AZ0168910
BCBS AZ
AZ
Enumeration date
06/27/2006
Last updated
12/06/2011
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