Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 300352 | NC |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 300352 | NC |
NPI | 1245215896 |
---|---|
Provider Name | Anita R Smith |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10186421 | (05) | VA |
7003526 | (05) | NC |
7241729 | AETNA (01) | |
D8019 | MEDCOST (01) |