Provider Demographics
NPI:1861565251
Name:SMELTZER, CAROLYN DAWN (PNP, FNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DAWN
Last Name:SMELTZER
Suffix:
Gender:F
Credentials:PNP, FNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DAWN
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-388-3216
Mailing Address - Fax:623-388-3216
Practice Address - Street 1:9520 W PALM LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4403
Practice Address - Country:US
Practice Address - Phone:623-388-3216
Practice Address - Fax:623-388-4902
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN147798163WP0200X
AZAP2820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348712Medicaid
AZ048588Medicaid