Provider Demographics
NPI:1497482285
Name:SMITH, DARIEN DANIELLE
Entity Type:Individual
Prefix:
First Name:DARIEN
Middle Name:DANIELLE
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 1:601 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2758
Mailing Address - Country:US
Mailing Address - Phone:360-931-5552
Mailing Address - Fax:
Practice Address - Street 1:700 VETERANS DR
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-9757
Practice Address - Country:US
Practice Address - Phone:541-296-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program