Individual
DR. MARYANN SMOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-C
Contact information
Practice address
1350 PARKWAY DR, BLACKFOOT, ID 83221-1657
(208) 782-2410
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1799
(208) 782-2410
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
45147
ID
363LF0000X
Family Nurse Practitioner
Primary
65652
ID
Other
Enumeration date
09/09/2020
Last updated
05/12/2021
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