Provider Demographics
NPI:1407349319
Name:SMITH, ANNA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 NIGHTHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:BRAYTON
Mailing Address - State:IA
Mailing Address - Zip Code:50042-7545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 6600
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5411
Practice Address - Country:US
Practice Address - Phone:505-724-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical