Provider Demographics
NPI:1386621472
Name:SMITH, STEFANIE LYNN (CRNA)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2000 E LAMAR BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7346
Mailing Address - Country:US
Mailing Address - Phone:214-648-7833
Mailing Address - Fax:214-648-6799
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-7833
Practice Address - Fax:214-648-6799
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX696254367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40499Medicare UPIN
TX8G0672Medicare ID - Type Unspecified607K
TX8G0672Medicare PIN