Provider Demographics
NPI:1982456026
Name:MIQUELLE M SMITH APRN PLLC
Entity Type:Organization
Organization Name:MIQUELLE M SMITH APRN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIQUELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-619-0999
Mailing Address - Street 1:9600 S 1300 E STE 235
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3785
Mailing Address - Country:US
Mailing Address - Phone:801-619-0999
Mailing Address - Fax:801-619-4999
Practice Address - Street 1:9600 S 1300 E STE 235
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3785
Practice Address - Country:US
Practice Address - Phone:801-619-0999
Practice Address - Fax:801-619-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty