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NPI Code Detail

MEDICARE: MARILYN G SMITH NP

MEDICARE: MARILYN G SMITH NP
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
1363LF0000XFamily Nurse Practitioner200641NC

General Provider Information

NPI Number : 1255306510
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN G SMITH NP
Provider Business Mailing Address
First Line : 19518 CROSSTREE LN
Second Line :
City : CORNELIUS
State : NC
Zip : 28031-5708
Country : US
Telephone Number : 704-987-0748
Fax Number :
Provider Business Practice Location Address
First Line : 14230 HUNTERS RD
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7335
Country : US
Telephone Number : 704-947-6858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 09/26/2008

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