Provider Demographics
NPI:1740008002
Name:SMOOT, HANNAH LAUREN
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LAUREN
Last Name:SMOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NW 192ND ST APT 31205
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-9265
Mailing Address - Country:US
Mailing Address - Phone:918-704-8304
Mailing Address - Fax:
Practice Address - Street 1:2800 NW 192ND ST APT 31205
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9265
Practice Address - Country:US
Practice Address - Phone:918-704-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program