Provider Demographics
NPI:1801869664
Name:SMITH, TODD M (ARNP)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:15812 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1875
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:509-434-0392
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2022-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30006301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB39203Medicare ID - Type Unspecified
WAP97252Medicare UPIN
WA9636986Medicaid