Individual
ELIZABETH MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
367 E MAIN ST STE A, WATERLOO, NY 13165-1643
(315) 787-4977
Mailing address
367 E MAIN ST STE A, WATERLOO, NY 13165-1643
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
345546
NY
363LP2300X
Primary Care Nurse Practitioner
Primary
345546
NY
Other
Enumeration date
02/17/2020
Last updated
02/24/2020
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