Healthcare Provider Details

I. General information

NPI: 1871737783
Provider Name (Legal Business Name): BLENDA E SMITH FNP,PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FRONT ST
BINGHAMTON NY
13905-2424
US

IV. Provider business mailing address

225 FRONT ST
BINGHAMTON NY
13905-2424
US

V. Phone/Fax

Practice location:
  • Phone: 607-778-2839
  • Fax: 607-778-2873
Mailing address:
  • Phone: 607-778-2839
  • Fax: 607-778-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: