Provider Demographics
NPI:1932871415
Name:SMITH, EMILY MARIE (DNP)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 W CHARLEY WAY
Mailing Address - Street 2:
Mailing Address - City:ERDA
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9413
Mailing Address - Country:US
Mailing Address - Phone:575-520-2164
Mailing Address - Fax:
Practice Address - Street 1:581 W CHARLEY WAY
Practice Address - Street 2:
Practice Address - City:ERDA
Practice Address - State:UT
Practice Address - Zip Code:84074-9413
Practice Address - Country:US
Practice Address - Phone:575-520-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11030575-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner