Individual
MIQUELLE M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
219852-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219852-4405
STATE LICENSE
UT
Enumeration date
05/17/2007
Last updated
07/08/2007
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