Healthcare Provider Details

I. General information

NPI: 1679561104
Provider Name (Legal Business Name): DENNIS SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

PO BOX 947
CHAMBERSBURG PA
17201-0947
US

V. Phone/Fax

Practice location:
  • Phone: 717-228-1620
  • Fax:
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN175222L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: