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General NPI Number Information
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NPI Number | 1891975959
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Entity Type | Individual
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Provider Name | THERESA SHARP SMIGO MSN, CRNP, CNS, RN-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 03/20/2021
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Provider Practice Location Address
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Address Line | 210 N 9TH ST
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City | PHILA
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State | PA
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Zip | 19107-1813
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Country | US
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Telephone | 267-337-1534
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Fax |
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Provider Business Mailing Address
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Address Line | 404 AURA RD
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City | GLASSBORO
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State | NJ
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Zip | 08028-3206
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Country | US
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Telephone | 267-337-1534
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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 | TP006435C
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License Number State | PA
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