Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5006483 | NC |
NPI | 1023446424 |
---|---|
Provider Name | Dana Nichols Smith |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2013 |
Last Update Date | 24/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023446424 | (05) | NC |