Healthcare Provider Details

I. General information

NPI: 1497845515
Provider Name (Legal Business Name): MARCIA RENEE SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W CHESTNUT ST SUITE 400
WASHINGTON PA
15301-4524
US

IV. Provider business mailing address

2305 MCNARY BLVD
PITTSBURGH PA
15235-2737
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-7113
  • Fax: 724-228-8587
Mailing address:
  • Phone: 412-242-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP000939G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: