Healthcare Provider Details

I. General information

NPI: 1659434033
Provider Name (Legal Business Name): BARBARA ELLEN SMITH C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA ELLEN FESSENDEN C.R.N.P.

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 S 4TH ST PLANNED PARENTHOOD KEYSTONE
READING PA
19602-1047
US

IV. Provider business mailing address

PO BOX 813 PLANNED PARENTHOOD KEYSTONE
TREXLERTOWN PA
18087-0813
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-0481
  • Fax: 610-481-0486
Mailing address:
  • Phone: 610-481-0481
  • Fax: 610-481-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN348762LRN
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP004796HCRNP
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP009952-CRNP
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: