Provider Demographics
NPI:1659522142
Name:SMITH, DAVID CRUSE (NREMT-B,LPN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CRUSE
Last Name:SMITH
Suffix:
Gender:M
Credentials:NREMT-B,LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0043
Mailing Address - Country:US
Mailing Address - Phone:907-442-2189
Mailing Address - Fax:
Practice Address - Street 1:436TH & 5TH TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0758
Practice Address - Country:US
Practice Address - Phone:907-442-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5066164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse