Provider Demographics
NPI:1316682909
Name:SMITH, NATHAN RAYMOND
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:RAYMOND
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1257
Mailing Address - Country:US
Mailing Address - Phone:207-994-3917
Mailing Address - Fax:
Practice Address - Street 1:69 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1257
Practice Address - Country:US
Practice Address - Phone:207-994-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider