Individual
IAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 FORT WASHINGTON AVE, MAPLE GLEN, PA 19002-3025
(215) 407-7643
Mailing address
1800 FORT WASHINGTON AVE, MAPLE GLEN, PA 19002-3025
(215) 407-7643
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
PA669910
PA
163W00000X
Registered Nurse
RN.1686630
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
APN.0998313-CRNA
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992
—
CO
Enumeration date
11/17/2022
Last updated
01/07/2023
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