Individual
MS. CARMEN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 295-9360
(703) 295-9369
Mailing address
3998 FAIR RIDGE DRIVE, SUITE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024165880
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083780118
—
VA
01
—
139180
TRIGON
VA
01
—
484645
NCPPO
VA
01
—
K142-0002
CARE FIRST 2005
VA
01
—
P00265736
MEDICARE RAILROAD
VA
Enumeration date
11/28/2006
Last updated
03/20/2015
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