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General NPI Number Information
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NPI Number | 1194330407
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Entity Type | Individual
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Provider Name | MIRANDA LAUREN SMITH FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 04/08/2023
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Provider Practice Location Address
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Address Line | 7 MAIN RD NORTH
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City | HAMPDEN
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State | ME
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Zip | 04444
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Country | US
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Telephone | 207-862-9464
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Fax | 207-862-9411
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Provider Business Mailing Address
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Address Line | 7 MAIN RD NORTH
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City | HAMPDEN
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State | ME
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Zip | 04444
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Country | US
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Telephone | 207-862-9464
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Fax | 207-862-9411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001260120
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024180173
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP211299
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License Number State | ME
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