Healthcare Provider Details

I. General information

NPI: 1215573860
Provider Name (Legal Business Name): EMILIE ANN SMITH WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 ARLINGTON BLVD SUITE 500
FAIRFAX VA
22031-4631
US

IV. Provider business mailing address

8501 ARLINGTON BLVD STE 500
FAIRFAX VA
22031-4631
US

V. Phone/Fax

Practice location:
  • Phone: 571-766-3376
  • Fax: 855-758-2634
Mailing address:
  • Phone: 571-766-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number0024178196
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: