Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5009673 | NC |
NPI | 1023531316 |
---|---|
Provider Name | Jamie Stein Smolko |
First Address | Somerville, MA 02144-3032 |
Second Address | Carrboro, NC 27510-1849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 19/11/2019 |