Healthcare Provider Details

I. General information

NPI: 1740896448
Provider Name (Legal Business Name): ELIZABETH SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR STE 660
BETHESDA MD
20817-1915
US

IV. Provider business mailing address

516 58TH ST NE
WASHINGTON DC
20019-6911
US

V. Phone/Fax

Practice location:
  • Phone: 301-571-0019
  • Fax: 240-482-0555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR239721
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR239721
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: