MEDICARE: MRS. SARAH SMITH CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	SP017586	PA

General Provider Information

NPI Number	:	1194246199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH SMITH CRNP

Provider Business Mailing Address
First Line	:	103 PINEHURST WAY
Second Line	:
City	:	GILBERTSVILLE
State	:	PA
Zip	:	19525-8648
Country	:	US
Telephone Number	:	610-322-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 COWPATH RD STE 1
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-1152
Country	:	US
Telephone Number	:	215-855-1599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	07/21/2022

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