Provider Demographics
NPI:1316214760
Name:SMITH, VERONICA RAE ANN (RN, MSN, CNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:RAE ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, MSN, CNP
Other - Prefix:
Other - First Name:RAE ANN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, CNP
Mailing Address - Street 1:2711 RANDOLPH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2027
Mailing Address - Country:US
Mailing Address - Phone:704-342-1900
Mailing Address - Fax:704-377-0353
Practice Address - Street 1:2711 RANDOLPH RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2027
Practice Address - Country:US
Practice Address - Phone:704-342-1900
Practice Address - Fax:704-377-0353
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005402363L00000X, 364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology