Provider Demographics
NPI:1427109867
Name:SMOLENSKI, MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:SMOLENSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-1802
Mailing Address - Country:US
Mailing Address - Phone:267-679-4515
Mailing Address - Fax:
Practice Address - Street 1:2510 MARYLAND RD
Practice Address - Street 2:SUITE 160
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1109
Practice Address - Country:US
Practice Address - Phone:215-672-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008722363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA219687V0UMedicare PIN