Provider Demographics
NPI:1649373200
Name:SMITH, MARY HELEN (FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:HELEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 INGLEWOOD BLVD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5896
Mailing Address - Country:US
Mailing Address - Phone:310-392-8636
Mailing Address - Fax:310-664-7426
Practice Address - Street 1:4700 INGLEWOOD BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5896
Practice Address - Country:US
Practice Address - Phone:310-392-8630
Practice Address - Fax:310-664-7426
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295050163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP1913EMedicare ID - Type Unspecified
CAWNP1913BMedicare ID - Type Unspecified
CAWNP1913CMedicare ID - Type Unspecified
CAWNP1913DMedicare ID - Type Unspecified