Basic Information
| Provider Information | |||||||||
| NPI: | 1023290087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 355 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927020355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967806 | ||||||||
| FaxNumber: | 7148967808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 W 17TH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927062316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967806 | ||||||||
| FaxNumber: | 7148967808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 424689 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.