Individual
DOROTHEA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
002890
CT
363LW0102X
Women's Health Nurse Practitioner
Primary
2890
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004249696
—
CT
01
—
500001470
MEDICARE OTHER
CT
Enumeration date
05/19/2006
Last updated
11/07/2016
Update your record
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