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General NPI Number Information
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NPI Number | 1952053225
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Entity Type | Individual
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Provider Name | STACEY NICOLE SMITH RN
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 30 HUNTER LN
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City | CAMP HILL
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State | PA
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Zip | 17011-2400
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Country | US
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Telephone | 800-748-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 2127 WOODWIND DR
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City | ENCINITAS
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State | CA
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Zip | 92024-6434
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Country | US
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Telephone | 410-353-0526
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN786992
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License Number State | CA
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