Provider Demographics
NPI:1194773093
Name:SMITH, MELINDA F (APRN)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:555 WILLARD AVENUE/VA CONNECTICUT
Mailing Address - Street 2:PRIMARY CARE/VA CT
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06011
Mailing Address - Country:US
Mailing Address - Phone:860-666-6951
Mailing Address - Fax:860-667-6875
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:PRIMARY CARE/VA CT
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-666-6951
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001175363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health