Provider Demographics
NPI:1063833192
Name:ATALIG-SMITH, AMELIA (RN, CCRN, ANP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:ATALIG-SMITH
Suffix:
Gender:F
Credentials:RN, CCRN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 MT DIABLO BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3746
Mailing Address - Country:US
Mailing Address - Phone:510-204-6660
Mailing Address - Fax:
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:2ND FLOOR, SUITE 2549
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-869-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000132363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health