Provider Demographics
NPI:1356302624
Name:SMITHERS, JACQUELINE M (CNM)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7084 S 2300 E
Mailing Address - Street 2:STE 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3975
Mailing Address - Country:US
Mailing Address - Phone:801-733-0555
Mailing Address - Fax:801-942-5897
Practice Address - Street 1:7084 S 2300 E
Practice Address - Street 2:STE 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3975
Practice Address - Country:US
Practice Address - Phone:801-733-0555
Practice Address - Fax:801-733-0555
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT224404-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS82745Medicare UPIN
UT000071002Medicare ID - Type UnspecifiedMEDICARE NUMBER