MEDICARE: MRS. COURTNEY 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
1	363LA2200X	Adult Health Nurse Practitioner	306075	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467717454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY G SMITH NP

Provider Business Mailing Address
First Line	:	908 NIAGARA FALLS BLVD STE 208
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2019
Country	:	US
Telephone Number	:	716-692-3302
Fax Number	:	716-692-4342

Provider Business Practice Location Address
First Line	:	705 MAPLE RD STE 300
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-3291
Country	:	US
Telephone Number	:	716-710-8266
Fax Number	:	716-710-8267

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	10/02/2017

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