Individual
JEANNE BETZ SMOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
915 TOLL HOUSE AVE STE 103, FREDERICK, MD 21701-5911
(410) 328-6403
(410) 328-6405
Mailing address
198 THOMAS JOHNSON DRIVE, SUITE 5, FREDERICK, MD 21702
(301) 624-5390
(301) 624-5393
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
R112789
MD
363LG0600X
Gerontology Nurse Practitioner
R112789
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
613335-01
BLUE CROSS/BLUE SHIELD
MD
05
—
699065700
—
MD
Enumeration date
06/11/2006
Last updated
04/17/2019
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