Individual
TANYA MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(304) 598-1460
(304) 598-1457
Mailing address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(304) 598-1460
(304) 598-1457
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
55365
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55365
STATE LICENSE
WV
Enumeration date
06/02/2010
Last updated
06/02/2010
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