Provider Demographics
NPI:1326032004
Name:SMITH, DEIRDRE (RNP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-943-1300
Mailing Address - Fax:401-946-8480
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-943-1300
Practice Address - Fax:401-946-8480
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPPRI37121363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007057350Medicare ID - Type Unspecified
RI007057350Medicare PIN
RIQ36723Medicare UPIN