Provider Demographics
NPI:1144321738
Name:SMITH, JOYCE A (NP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:SMITH
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:PO BOX 4004
Mailing Address - Street 2:STUDENT HEALTH SERVICE
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-4004
Mailing Address - Country:US
Mailing Address - Phone:715-836-4311
Mailing Address - Fax:715-836-5979
Practice Address - Street 1:105 GARFIELD AVE
Practice Address - Street 2:STUDENT HEALTH SERVICE
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4811
Practice Address - Country:US
Practice Address - Phone:715-836-4311
Practice Address - Fax:715-836-5979
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43815600Medicaid
S79290Medicare UPIN
WI005720270Medicare ID - Type Unspecified