Provider Demographics
NPI:1841956653
Name:SMITH, JENNIFER VANESSA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VANESSA
Last Name:SMITH
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 1:7016 SILVER MOUNTAIN LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-6726
Mailing Address - Country:US
Mailing Address - Phone:505-206-6631
Mailing Address - Fax:
Practice Address - Street 1:8300 CARMEL AVE NE STE 601
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3125
Practice Address - Country:US
Practice Address - Phone:505-677-8842
Practice Address - Fax:505-501-7451
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR56398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse