Provider Demographics
NPI:1154418432
Name:SMITH, LOIS KACHWER (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:KACHWER
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:LOIS
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-512-5363
Mailing Address - Fax:704-512-2428
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-512-5363
Practice Address - Fax:704-512-2428
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900050363L00000X
NC132225363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154418432Medicaid
SCNP1613Medicaid
NC7000233Medicaid
NC1154418432Medicaid
NCNC7268BMedicare PIN