Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024177131 | VA |
NPI | 1013480110 |
---|---|
Provider Name | Penny Chrystal Smith |
First Address | Williamsburg, VA 23185-2113 |
Second Address | Norfolk, VA 23507-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 10/01/2019 |