Basic Information
| Provider Information | |||||||||
| NPI: | 1447689682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | NOELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5545 N FLINT AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202458024 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 S 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206291814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2013 | ||||||||
| LastUpdateDate: | 11/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CRNA0989 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.