Provider Demographics
NPI:1124199963
Name:SMITH, CATHERINE MARIE (CPNP, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2316
Mailing Address - Country:US
Mailing Address - Phone:714-834-8137
Mailing Address - Fax:714-834-8361
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-8325
Practice Address - Fax:714-834-8361
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR229753363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health