Provider Demographics
NPI:1851475792
Name:SMITH, ELIZABETH D (CPNP, ANP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ESSJAY RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8208
Mailing Address - Country:US
Mailing Address - Phone:716-445-2013
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:300 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8208
Practice Address - Country:US
Practice Address - Phone:716-445-2013
Practice Address - Fax:716-839-6740
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415198163W00000X
NYF381387363LP0200X
NYF305061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02345462Medicaid
061212000042OtherFIDELIS
00027840501OtherUNIVERA
000560590002OtherBC/BS
9512029OtherIHA
NY02345462Medicaid
9512029OtherIHA