Provider Demographics
NPI:1093602633
Name:SMITH, MARY SYLVIA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SYLVIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N 4TH ST APT 3-101
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7826
Mailing Address - Country:US
Mailing Address - Phone:928-310-2309
Mailing Address - Fax:
Practice Address - Street 1:1001 N 4TH ST APT 3-101
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7826
Practice Address - Country:US
Practice Address - Phone:928-310-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF06250240363LF0000X
AZRNP325509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily