Provider Demographics
NPI:1073091427
Name:SMITH, JOSEPH G (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-0282
Mailing Address - Country:US
Mailing Address - Phone:360-509-8476
Mailing Address - Fax:
Practice Address - Street 1:9177 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8519
Practice Address - Country:US
Practice Address - Phone:360-307-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60225557163WE0003X
WAAP60896900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergency