Healthcare Provider Details

I. General information

NPI: 1285069112
Provider Name (Legal Business Name): MARTHA LYNN SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CHAPEL ST
SHERBURNE NY
13460
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 607-674-2445
  • Fax: 607-674-4338
Mailing address:
  • Phone: 607-674-2445
  • Fax: 607-674-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: