Healthcare Provider Details

I. General information

NPI: 1881510444
Provider Name (Legal Business Name): DEANNA SMITH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 OAK ST
EAST BRIDGEWATER MA
02333-1215
US

IV. Provider business mailing address

24 CHURCH ST
CANTON MA
02021-2936
US

V. Phone/Fax

Practice location:
  • Phone: 781-206-9937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2349677
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: