Individual
ROSE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
400 SUNRISE HWY, AMITYVILLE, NY 11701-2508
(631) 608-5610
Mailing address
18 ANNETTA AVE, NORTHPORT, NY 11768-1802
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2310398
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402327
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184163578
—
NY
Enumeration date
02/17/2017
Last updated
03/22/2018
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