Provider Demographics
NPI:1962172387
Name:SMYTH, CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SMYTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 EL CAMINO REAL STE 202
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3214
Mailing Address - Country:US
Mailing Address - Phone:650-692-9751
Mailing Address - Fax:650-697-0729
Practice Address - Street 1:1750 EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3214
Practice Address - Country:US
Practice Address - Phone:650-692-9751
Practice Address - Fax:650-697-0729
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily