MEDICARE: COLENE M 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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	0024176338	VA

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	:	1730665670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLENE M SMITH NP

Provider Business Mailing Address
First Line	:	8239 MEADOWBRIDGE RD STE A
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2318
Country	:	US
Telephone Number	:	804-730-8713
Fax Number	:	804-730-0839

Provider Business Practice Location Address
First Line	:	8239 MEADOWBRIDGE RD STE A
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2318
Country	:	US
Telephone Number	:	804-730-8713
Fax Number	:	804-730-0839

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

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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