Healthcare Provider Details

I. General information

NPI: 1164746681
Provider Name (Legal Business Name): CHRISTINE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY 670
ANNAPOLIS MD
21401-3046
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1176
  • Fax: 410-224-0065
Mailing address:
  • Phone: 443-481-5047
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR140846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: