Provider Demographics
NPI:1467133348
Name:SMITHSON, SEAN RILEY (CRNP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:RILEY
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 WASHINGTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5779
Mailing Address - Country:US
Mailing Address - Phone:410-848-2444
Mailing Address - Fax:410-857-1634
Practice Address - Street 1:826 WASHINGTON RD STE 120
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5779
Practice Address - Country:US
Practice Address - Phone:410-848-2444
Practice Address - Fax:410-857-1634
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner