MEDICARE: MRS. VICTORIA EDWARDS SMITH OBNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	800037	NC

General Provider Information

NPI Number	:	1336144518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA EDWARDS SMITH OBNP

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	BOLIVIA
State	:	NC
Zip	:	28422-0009
Country	:	US
Telephone Number	:	910-253-2250
Fax Number	:	910-253-2370

Provider Business Practice Location Address
First Line	:	25 COURTHOUSE DR. NE
Second Line	:	BOX 9
City	:	BOLIVIA
State	:	NC
Zip	:	28422-7582
Country	:	US
Telephone Number	:	910-253-2250
Fax Number	:	910-253-2370

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/07/2023

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