Individual
JANUARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 W TABOR RD, PHILADELPHIA, PA 19141-3019
(215) 456-9800
Mailing address
5713 CHEW AVE, PHILADELPHIA, PA 19138-1715
(267) 279-6450
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP017673
PA
Other
Enumeration date
09/25/2017
Last updated
09/25/2017
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