Provider Demographics
NPI:1285669580
Name:SMITH, TERILYN (CRNP)
Entity Type:Individual
Prefix:
First Name:TERILYN
Middle Name:
Last Name:SMITH
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 1:5612 EASTON RD
Mailing Address - Street 2:P O BOX 866
Mailing Address - City:PLUMSTEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18949
Mailing Address - Country:US
Mailing Address - Phone:215-766-8844
Mailing Address - Fax:215-766-0733
Practice Address - Street 1:5612 EASTON RD
Practice Address - Street 2:
Practice Address - City:PLUMSTEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:18949
Practice Address - Country:US
Practice Address - Phone:215-766-8844
Practice Address - Fax:215-766-0733
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005090C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S70672Medicare UPIN
023049Medicare ID - Type Unspecified