Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 363LP2300X | IN |
NPI | 1013319367 |
---|---|
Provider Name | Sandra Smith |
First Address | Franklin, IN 46131-7734 |
Second Address | Columbus, IN 47203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 17/12/2014 |