Healthcare Provider Details

I. General information

NPI: 1801164017
Provider Name (Legal Business Name): CHARRON SMITH-MARSH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 OLD YORK RD
PHILADELPHIA PA
19126-2114
US

IV. Provider business mailing address

1108 CYPRESS RD
WILMINGTON DE
19810-1908
US

V. Phone/Fax

Practice location:
  • Phone: 215-424-4090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011247
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: