Provider Demographics
NPI:1770651176
Name:SMITH, DONNA FAYE (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:FAYE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG B 203B
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3847
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:BLDG B 203B
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-674-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily