Individual
MS. SUSAN SPIVOCK SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28548-2538
(910) 450-4159
(910) 450-4194
Mailing address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28548-2538
(910) 450-4159
(910) 450-4194
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R108147
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
553211600
—
MD
Enumeration date
06/16/2005
Last updated
10/25/2011
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