Provider Demographics
NPI:1104901198
Name:SMITH, NANCI HEATHER (RNFA)
Entity type:Individual
Prefix:
First Name:NANCI
Middle Name:HEATHER
Last Name:SMITH
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EDGEWATER PL
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1011
Mailing Address - Country:US
Mailing Address - Phone:973-265-4056
Mailing Address - Fax:
Practice Address - Street 1:6 EDGEWATER PL
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1011
Practice Address - Country:US
Practice Address - Phone:973-265-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06964400364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative