Provider Demographics
NPI:1689145229
Name:SMITH, ANNA M
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
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 1:450 W STATE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6056
Mailing Address - Country:US
Mailing Address - Phone:208-334-6530
Mailing Address - Fax:208-332-7331
Practice Address - Street 1:450 W STATE ST FL 5
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6056
Practice Address - Country:US
Practice Address - Phone:208-334-6530
Practice Address - Fax:208-332-7331
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other