Provider Demographics
NPI:1952689390
Name:SMITH, ETHEL ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2809 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1998
Mailing Address - Country:US
Mailing Address - Phone:702-476-9999
Mailing Address - Fax:
Practice Address - Street 1:1655 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3494
Practice Address - Country:US
Practice Address - Phone:702-476-9999
Practice Address - Fax:702-946-1343
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5466363LF0000X
OHCOA.12467-NP363LF0000X
NVAPRN001807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily