Provider Demographics
NPI:1437470333
Name:SMITH, ELIZABETH WYSON (LDEM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WYSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:LDEM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 N STONE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5082
Mailing Address - Country:US
Mailing Address - Phone:435-673-9898
Mailing Address - Fax:
Practice Address - Street 1:297 N STONE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5082
Practice Address - Country:US
Practice Address - Phone:435-673-9898
Practice Address - Fax:435-673-9898
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6333509-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife