Provider Demographics
NPI:1962819680
Name:SMITH, EMILY (RN, NP)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 BROADWAY # 580
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5642
Mailing Address - Country:US
Mailing Address - Phone:405-873-7212
Mailing Address - Fax:
Practice Address - Street 1:2578 BROADWAY # 580
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5642
Practice Address - Country:US
Practice Address - Phone:405-873-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1962819680363LW0102X
NYF421169-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1962819680Medicaid