Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP020377 | PA |
NPI | 1003204033 |
---|---|
Provider Name | Ms. Whitney Smith |
First Address | Philadelphia, PA 19178-3311 |
Second Address | East Stroudsburg, PA 18301-9207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2014 |
Last Update Date | 14/11/2019 |