Healthcare Provider Details

I. General information

NPI: 1164516746
Provider Name (Legal Business Name): LETONYA MARIA SMITH C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR SUITE 304
BALTIMORE MD
21237-3930
US

IV. Provider business mailing address

1838 GREENE TREE RD STE 135
PIKESVILLE MD
21208-7108
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-6351
  • Fax: 410-391-0427
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR123696
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: