Provider Demographics
NPI:1194330407
Name:SMITH, MIRANDA LAUREN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:LAUREN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:MIRANDA
Other - Middle Name:LAUREN
Other - Last Name:CRABTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:7 MAIN RD NORTH
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444
Mailing Address - Country:US
Mailing Address - Phone:207-862-9464
Mailing Address - Fax:207-862-9411
Practice Address - Street 1:7 MAIN RD NORTH
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444
Practice Address - Country:US
Practice Address - Phone:207-862-9464
Practice Address - Fax:207-862-9411
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001260120163W00000X
VA0024180173363LF0000X
MECNP211299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse