MEDICARE: COURTNEY G SMITH

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	367500000X	Certified Registered Nurse Anesthetist	491696	NY

General Provider Information

NPI Number	:	1285849133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY G SMITH

Provider Business Mailing Address
First Line	:	633 3RD AVE
Second Line	:	BOX 3
City	:	NEW YORK
State	:	NY
Zip	:	10017-6706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 3RD AVE
Second Line	:	BOX 3
City	:	NEW YORK
State	:	NY
Zip	:	10017-6706
Country	:	US
Telephone Number	:	516-663-2216
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	06/28/2023

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