Provider Demographics
NPI:1871987826
Name:SMITH, SARAH ANNE (DNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2555
Mailing Address - Country:US
Mailing Address - Phone:307-363-5930
Mailing Address - Fax:888-720-0569
Practice Address - Street 1:623 N COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2555
Practice Address - Country:US
Practice Address - Phone:307-363-5930
Practice Address - Fax:888-270-0569
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY28427163W00000X
WY28427.1651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse