Provider Demographics
NPI:1306228218
Name:SMITH, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 S KINGS RANCH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-7352
Mailing Address - Country:US
Mailing Address - Phone:480-761-2500
Mailing Address - Fax:480-288-2879
Practice Address - Street 1:6410 S KINGS RANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-7352
Practice Address - Country:US
Practice Address - Phone:480-761-2500
Practice Address - Fax:480-288-2879
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily