Individual
MRS. SUSAN J SMITH
Active
Individual
MRS. SUSAN J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC FNP
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
108177
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425270907
—
MO
05
—
425270923
—
MO
05
—
425270931
—
MO
05
—
425270949
—
MO
05
—
425270956
—
MO
Enumeration date
06/14/2007
Last updated
12/18/2013
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