Individual
ANITA R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
300352
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
300352
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10186421
—
VA
05
—
7003526
—
NC
01
—
7241729
AETNA
—
01
—
D8019
MEDCOST
—
Enumeration date
12/07/2005
Last updated
12/18/2007
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