Provider Demographics
NPI:1285813816
Name:SMITH, VIRGINIA KEEFE (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:KEEFE
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 1:71 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1530
Mailing Address - Country:US
Mailing Address - Phone:631-754-0973
Mailing Address - Fax:
Practice Address - Street 1:71 FOREST DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1530
Practice Address - Country:US
Practice Address - Phone:631-754-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346089-1163W00000X
NYF303700-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse