Provider Demographics
NPI:1073041836
Name:REANEY-SMITH, ROBIN THERESE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:THERESE
Last Name:REANEY-SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:THERESE
Other - Last Name:REANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:3325 RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7913
Practice Address - Country:US
Practice Address - Phone:775-887-5140
Practice Address - Fax:775-884-3618
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54010OtherCALIFORNIA PA LICENSE