Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 332249 | NY |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 332249 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F332249-1 | NY |
NPI | 1063482149 |
---|---|
Provider Name | Linda J Smith |
First Address | Elmira, NY 14901-3230 |
Second Address | Corning, NY 14830-2959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 01/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01867981 | (05) | NY |