Provider Demographics
NPI:1952096315
Name:SMITH, EMILY JEAN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
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 1:875 BLAKE WILBUR DRIVE
Mailing Address - Street 2:CC-G222
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5847
Mailing Address - Country:US
Mailing Address - Phone:650-724-7673
Mailing Address - Fax:650-725-8231
Practice Address - Street 1:875 BLAKE WILBUR DRIVE
Practice Address - Street 2:CC-G222
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5847
Practice Address - Country:US
Practice Address - Phone:650-724-7673
Practice Address - Fax:650-725-8231
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program