Healthcare Provider Details

I. General information

NPI: 1336467539
Provider Name (Legal Business Name): BELINDA LUCE SMITH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 JEFFERSON ST 3RD FLOOR-NEWARK COMMUNITY HEALTH CENTERS, INC.
NEWARK NJ
07105-1706
US

IV. Provider business mailing address

275 LAFAYETTE AVE
HAWTHORNE NJ
07506-1919
US

V. Phone/Fax

Practice location:
  • Phone: 973-465-2828
  • Fax: 973-465-2862
Mailing address:
  • Phone: 865-789-2768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00287600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: