Provider Demographics
NPI:1689180101
Name:SMITH, BARBARA NELL
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:NELL
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 1:2115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1663
Mailing Address - Country:US
Mailing Address - Phone:831-420-0120
Mailing Address - Fax:831-420-1057
Practice Address - Street 1:2115 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1663
Practice Address - Country:US
Practice Address - Phone:831-420-0120
Practice Address - Fax:831-420-1057
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN694142164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse