Provider Demographics
NPI:1457684110
Name:SMITH, MIYOSHI (APRN)
Entity Type:Individual
Prefix:
First Name:MIYOSHI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 8178
Mailing Address - Street 2:ATTN: SAN SIMON HEALTH CENTER US HIGHWAY 86
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-9726
Mailing Address - Country:US
Mailing Address - Phone:520-362-7089
Mailing Address - Fax:520-362-7080
Practice Address - Street 1:US HWY 86 MARKER 74 HC 01
Practice Address - Street 2:SAN SIMON HEALTH CTR 8178
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-9726
Practice Address - Country:US
Practice Address - Phone:520-362-7089
Practice Address - Fax:520-362-7080
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP4201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid