Healthcare Provider Details

I. General information

NPI: 1174681258
Provider Name (Legal Business Name): DONNA CORINNE SMITH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA CORINNE WILSON

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 MEDICAL PARK DR SUITE 210
SILER CITY NC
27344-6790
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 919-742-6032
  • Fax: 919-663-3018
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: