Provider Demographics
NPI:1417522301
Name:SMITH, HEATHER DAWN (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE A331
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2538
Mailing Address - Country:US
Mailing Address - Phone:972-566-8317
Mailing Address - Fax:972-566-8145
Practice Address - Street 1:7777 FOREST LN STE A331
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2538
Practice Address - Country:US
Practice Address - Phone:972-566-8317
Practice Address - Fax:972-566-8145
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program