Individual
KATRINA WYNN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
17806 TIDE LINE DR, LATHROP, CA 95330-8273
(828) 713-2352
Mailing address
17806 TIDE LINE DR, LATHROP, CA 95330-8273
(828) 713-2352
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95029203
CA
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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