Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP125136 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 786628 | TX |
NPI | 1255751996 |
---|---|
Provider Name | Maura Smith |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
348655701 | (05) | TX |
348655702 | (05) | TX |
348655705 | (05) | TX |
348655706 | MEDICAID CSHCN (01) | TX |
8417NW | BCBS (01) | TX |
8664NM | BCBS (01) | TX |