Provider Demographics
NPI:1295189264
Name:SMART, SEAN M (DNP)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:SMART
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5429
Mailing Address - Country:US
Mailing Address - Phone:207-730-1725
Mailing Address - Fax:
Practice Address - Street 1:300 E JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6221
Practice Address - Country:US
Practice Address - Phone:208-322-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID53509OtherIDAHO NP LICENSE
IDN41662OtherIDAHO RN LICENSE
MERN54644OtherMAINE RN LICENSE