Healthcare Provider Details

I. General information

NPI: 1013290089
Provider Name (Legal Business Name): CHERYL SMITH RN (BSN AND MSHEP);
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date: 10/04/2013
Reactivation Date: 03/09/2017

III. Provider practice location address

01 HOME OFFICE
TOWSON MD
21286
US

IV. Provider business mailing address

1810 J YORK RD #383
LUTHERVILLE MD
21093-5165
US

V. Phone/Fax

Practice location:
  • Phone: 301-938-8539
  • Fax: 410-866-2507
Mailing address:
  • Phone: 301-938-8539
  • Fax: 410-866-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR165812
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: