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General NPI Number Information
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NPI Number | 1679097646
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Entity Type | Individual
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Provider Name | CATHRYN QUENNA SMITH
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 326 WASHINGTON ST
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City | NORWICH
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State | CT
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Zip | 06360-2740
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Country | US
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Telephone | 860-889-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 119 ALLISON DR
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City | TORRINGTON
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State | CT
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Zip | 06790-3147
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4246
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License Number State | CT
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