Basic Information
| Provider Information | |||||||||
| NPI: | 1861742785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 SW ABBEY STREET | ||||||||
| Address2: | SAMARITAN PACIFIC COMMUNITIES HOSPITAL | ||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412652244 | ||||||||
| FaxNumber: | 5415741858 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 MENAUL BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871071851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723000 | ||||||||
| FaxNumber: | 5052722014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 133V00000X | LD-1063 | NM | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.