Provider Demographics
NPI:1942636410
Name:SMITH, CHRISTINE ANN
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
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 1:41810 N VENTURE DR
Mailing Address - Street 2:UNIT E160
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3177
Mailing Address - Country:US
Mailing Address - Phone:623-233-0025
Mailing Address - Fax:623-266-3053
Practice Address - Street 1:41810 N VENTURE DR UNIT E160
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3177
Practice Address - Country:US
Practice Address - Phone:623-233-0025
Practice Address - Fax:623-266-3053
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4921363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health