Provider Demographics
NPI:1194909176
Name:SMITH, JEFFREY MARTIN (RNFA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-1763
Mailing Address - Country:US
Mailing Address - Phone:650-307-2703
Mailing Address - Fax:
Practice Address - Street 1:477 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-1763
Practice Address - Country:US
Practice Address - Phone:650-307-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569124163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant