Provider Demographics
NPI:1154639359
Name:SMITH, GEORGIA JAQUETTE (RN, OCN)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:JAQUETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HARDING AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4861
Mailing Address - Country:US
Mailing Address - Phone:715-461-0463
Mailing Address - Fax:
Practice Address - Street 1:1720 HARDING AVE STE 1
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4861
Practice Address - Country:US
Practice Address - Phone:715-461-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166730-030163W00000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163W00000XNursing Service ProvidersRegistered Nurse