Healthcare Provider Details

I. General information

NPI: 1821340035
Provider Name (Legal Business Name): JULIA M SMITH ACNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NATIONWIDE DR SUITE A
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

121 NATIONWIDE DRIVE SUITE A
LYNCHBURG VA
24502
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-1862
  • Fax: 434-384-7704
Mailing address:
  • Phone: 434-384-1862
  • Fax: 434-384-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024170396
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: