Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R073596 | MD |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SP008240 | PA |
NPI | 1316978711 |
---|---|
Provider Name | Ms. Stacie Lynn Smith |
First Address | Athens, GA 30606-7826 |
Second Address | Camp Hill, PA 17011-2204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 18/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107615 | JOHNS HOPKINS (01) | PA |
1551725 | GATEWAY-WMG (01) | PA |
533656 | CAREFIRST MD BCBS (01) | MD |