Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 2192 | CT |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2192 | CT |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2192 | CT |
NPI | 1023181534 |
---|---|
Provider Name | Dr. Craig Alan Smith |
First Address | Enfield, CT 06082-2349 |
Second Address | Ellington, CT 06029-4247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 16/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P39006 | (02) |