Healthcare Provider Details

I. General information

NPI: 1255213104
Provider Name (Legal Business Name): ELENA CHANG SMITH BSN, RN, SRNA, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W SEVENTH ST
FREDERICK MD
21701-4506
US

IV. Provider business mailing address

2613 OSPREY WAY
FREDERICK MD
21701-1917
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC009262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: