Provider Demographics
NPI:1801501689
Name:SMFMC LLC
Entity type:Organization
Organization Name:SMFMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GALANG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:725-204-1008
Mailing Address - Street 1:4840 E. BONANZA RD
Mailing Address - Street 2:SUITE. 8
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110
Mailing Address - Country:US
Mailing Address - Phone:725-204-1008
Mailing Address - Fax:725-204-5877
Practice Address - Street 1:4840 E. BONANZA RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110
Practice Address - Country:US
Practice Address - Phone:725-204-1008
Practice Address - Fax:725-204-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty