Provider Demographics
NPI:1245255660
Name:SMITH, BETSY C (CNM)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NE 87TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1930
Mailing Address - Country:US
Mailing Address - Phone:360-719-2171
Mailing Address - Fax:360-719-2172
Practice Address - Street 1:416 NE 87TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1930
Practice Address - Country:US
Practice Address - Phone:360-719-2171
Practice Address - Fax:360-719-2172
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004086367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005793Medicaid
WA1005793Medicaid
WA1005793Medicaid