Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024179029 | VA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 0024179029 | VA |
NPI | 1003439662 |
---|---|
Provider Name | Tabitha Tram Smithers |
First Address | Richmond, VA 23226-3768 |
Second Address | Richmond, VA 23226-3768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2020 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | VA |