Individual
MISS ERICA YVONNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
HWY 264, MP 388, POLACCA, AZ 86042-4000
(928) 737-6201
(928) 737-6098
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
(928) 737-6201
(928) 737-6098
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
883089
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
01
—
HSZ076
MEDICARE
AZ
Enumeration date
02/05/2010
Last updated
02/05/2010
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