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General NPI Number Information
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NPI Number | 1740876689
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Entity Type | Individual
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Provider Name | DESIREE SMITH AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 90 RITCHIE HWY
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City | PASADENA
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State | MD
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Zip | 21122-4303
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Country | US
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Telephone | 410-987-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 16214 ELLIPSE TER
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City | BOWIE
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State | MD
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Zip | 20716-3242
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Country | US
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Telephone | 205-480-7458
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R222153
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License Number State | MD
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