Individual
MARCY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2211 LOMAS BLVD NE, 2ND FLOOR, ALBUQUERQUE, NM 87106-2745
(505) 272-3189
(505) 272-2330
Mailing address
4504 WAYNESBORO RD NW, ALBUQUERQUE, NM 87120-3823
(505) 897-8642
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R9390
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93369
MEDICAID NUMBER
NM
01
—
NM300999
PTAN NUMBER
NM
01
—
R9390
NURSING LICENSE
NM
Enumeration date
11/07/2005
Last updated
05/16/2012
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