Provider Demographics
NPI:1124278866
Name:SMITH, ELIZABETH A (CPNP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3799
Mailing Address - Country:US
Mailing Address - Phone:978-635-8700
Mailing Address - Fax:978-514-6324
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3799
Practice Address - Country:US
Practice Address - Phone:978-635-8700
Practice Address - Fax:978-514-6324
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2020-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA273971364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA273971OtherSTATE LICENSE