Individual
MRS. CHARLENE MARTIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
860 OMNI BLVD STE 110, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
Mailing address
860 OMNI BLVD STE 303, NEWPORT NEWS, VA 23606-4477
(757) 232-8769
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
0024170046
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
541188948
EMPLOYER'S TAX ID
VA
Enumeration date
06/15/2012
Last updated
12/10/2018
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