Healthcare Provider Details

I. General information

NPI: 1528281268
Provider Name (Legal Business Name): BETH ANN SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN-STANTON RDS
NEWARK DE
19718-0001
US

IV. Provider business mailing address

104 LAUREL DR
COATESVILLE PA
19320-1760
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-2602
  • Fax: 302-733-2410
Mailing address:
  • Phone: 610-380-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberLM-0000132
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberSP008249
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: