Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | R149608 | MD |
Y | 363LG0600X | Nurse Practitioner - Gerontology | R149608 | MD |
NPI | 1063164507 |
---|---|
Provider Name | Lorenda Beth Smith |
First Address | Great Mills, MD 20634-2156 |
Second Address | Leonardtown, MD 20650-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2022 |
Last Update Date | 26/01/2022 |