Individual
DOROTHEA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2 CHURCH ST., NEW HAVEN, CT 06519
(203) 787-2264
Mailing address
789 HOWARD AVE, NEW HAVEN, CT 06519-1304
(203) 688-5555
(203) 688-7274
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
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