Provider Demographics
NPI:1386325363
Name:SMITH, MARINN ELISHA
Entity type:Individual
Prefix:
First Name:MARINN
Middle Name:ELISHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W FOOTHILL VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-4635
Mailing Address - Country:US
Mailing Address - Phone:385-251-2865
Mailing Address - Fax:
Practice Address - Street 1:701 E 700 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1699
Practice Address - Country:US
Practice Address - Phone:801-794-7947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11774036-3102163W00000X
UT11774036-8900363LF0000X
UT11774036-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse