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NPI Code Detail

MEDICARE: MRS. MARY SMITH NP

MEDICARE: MRS. MARY SMITH NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WN0002XNeonatal Intensive Care Registered NurseR063119MD

General Provider Information

NPI Number : 1609848050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY SMITH NP
Provider Business Mailing Address
First Line : PO BOX 2130
Second Line :
City : GERMANTOWN
State : MD
Zip : 20875-2130
Country : US
Telephone Number : 240-364-2510
Fax Number :
Provider Business Practice Location Address
First Line : 1550 FOREST GLEN RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20910-1460
Country : US
Telephone Number : 240-364-2510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 07/08/2007

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