Individual
MS. JESSICA ELIZABETH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, CRNA
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(877) 558-6248
Mailing address
2 BLUEFIN CT, NEWPORT BEACH, CA 92663-2777
(619) 807-9025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
95001128
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95001128
CRNA LICENSE
CA
Enumeration date
05/07/2019
Last updated
05/07/2019
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