Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 0024178196 | VA |
NPI | 1215573860 |
---|---|
Provider Name | Emilie Ann Smith |
First Address | Fairfax, VA 22031-4631 |
Second Address | Fairfax, VA 22031-4631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |