Healthcare Provider Details

I. General information

NPI: 1659433290
Provider Name (Legal Business Name): DEBORAH J. SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MILLARD ST
DUNDEE NY
14837-9777
US

IV. Provider business mailing address

201 E MAIN ST APT. 5
PENN YAN NY
14527-1603
US

V. Phone/Fax

Practice location:
  • Phone: 607-243-8059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF331859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: