Provider Demographics
NPI:1508409889
Name:SMITH, COURTNEY ALEXANDRIA (MSM)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALEXANDRIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 16TH AVE NE APT 6
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-7100
Mailing Address - Country:US
Mailing Address - Phone:206-353-0540
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 54TH ST STE 264
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3571
Practice Address - Country:US
Practice Address - Phone:206-353-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife