Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F3020031 | NY |
NPI | 1063599595 |
---|---|
Provider Name | Mary Elizabeth Smith |
First Address | Olean, NY 14760-1513 |
Second Address | Salamanca, NY 14779-9625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000560328002 | BLUE CROSS (01) | NY |
0300F302003 | (05) | NY |
S65476 | (02) | NY |