MEDICARE: NANCY L SMITH PNP

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	86057	CO

General Provider Information

NPI Number	:	1639150964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY L SMITH PNP

Provider Business Mailing Address
First Line	:	1504 SPRING CREEK DR
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-3437
Country	:	US
Telephone Number	:	303-665-7969
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 W SOUTH BOULDER RD
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2412
Country	:	US
Telephone Number	:	303-666-7337
Fax Number	:	303-666-7379

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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