Healthcare Provider Details

I. General information

NPI: 1841019254
Provider Name (Legal Business Name): PENNY LYNN SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 COLESVILLE RD. #1100
SILVERSPRING MD
20910
US

IV. Provider business mailing address

909 RIDGEBROOK RD STE 300
SPARKS MD
21152
US

V. Phone/Fax

Practice location:
  • Phone: 443-383-9300
  • Fax:
Mailing address:
  • Phone: 443-383-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR255677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: