Individual
MRS. SERITA M SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
915 POQUONNOCK RD, GROTON, CT 06340-4257
(860) 446-0144
Mailing address
16 MAIN ST, ELLINGTON, CT 06029-3360
(860) 871-5402
(860) 871-5413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5034
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
5034
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008073642
—
CT
Enumeration date
07/31/2012
Last updated
05/10/2021
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