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General NPI Number Information
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NPI Number | 1639611767
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Entity Type | Individual
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Provider Name | RUSSELL SMITH RN., FNP
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Gender | Male
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 1230 BAY DALE DR
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City | ARNOLD
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State | MD
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Zip | 21012-2325
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Country | US
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Telephone | 410-757-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 LIZBEC CT
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City | CROFTON
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State | MD
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Zip | 21114-3246
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Country | US
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Telephone | 301-801-6725
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R182595
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License Number State | MD
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