Provider Demographics
NPI:1336445998
Name:SMITH, WESLEY PAUL (SFA-C)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:SFA-C
Other - Prefix:
Other - First Name:WESLEY
Other - Middle Name:PAUL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SFA-C
Mailing Address - Street 1:308 TUSCANY CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5941
Mailing Address - Country:US
Mailing Address - Phone:702-283-6196
Mailing Address - Fax:702-425-7480
Practice Address - Street 1:308 TUSCANY CT.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-283-6196
Practice Address - Fax:702-425-7480
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00F536246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant