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NPI Code Detail

MEDICARE: MS. MARTHA M SMITH APRN,BC

MEDICARE: MS. MARTHA M SMITH APRN,BC
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
1363LA2200XAdult Health Nurse Practitioner156000MO

General Provider Information

NPI Number : 1952427742
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARTHA M SMITH APRN,BC
Provider Business Mailing Address
First Line : PO BOX 217
Second Line :
City : HERCULANEUM
State : MO
Zip : 63048-0217
Country : US
Telephone Number : 636-931-4206
Fax Number : 636-931-5774
Provider Business Practice Location Address
First Line : 807 COLLINS DR
Second Line :
City : FESTUS
State : MO
Zip : 63028-2346
Country : US
Telephone Number : 636-931-4206
Fax Number : 636-931-5774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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