Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0024167593 | VA |
NPI | 1154593176 |
---|---|
Provider Name | Theresa G Smith |
First Address | Norfolk, VA 23502-3990 |
Second Address | Suffolk, VA 23434-8151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 21/01/2016 |