Individual
MRS. MARIA R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
801 POLE LINE RD W, SUITE 3880, TWIN FALLS, ID 83301-5810
(208) 814-8500
(208) 814-8960
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1391A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871914168
—
ID
Enumeration date
01/03/2014
Last updated
04/14/2014
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