Provider Demographics
NPI:1154421873
Name:SMIHULA, JOSEPH C (NP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:SMIHULA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:407 W COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5209
Mailing Address - Country:US
Mailing Address - Phone:575-627-9110
Mailing Address - Fax:575-623-2191
Practice Address - Street 1:3555 ROUND BARN CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1757
Practice Address - Country:US
Practice Address - Phone:707-528-1050
Practice Address - Fax:707-525-3874
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16859363LA2200X
CANP699679363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA699678OtherRN LICENSE
CA699679OtherNP LICENSE