Provider Demographics
NPI:1356483275
Name:SMITH, BEVERLY ELAINE (DNP,ANP-BC, NE-BC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP,ANP-BC, NE-BC
Other - Prefix:DR
Other - First Name:BEVERLY
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:564 1ST AVE APT 19M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6491
Mailing Address - Country:US
Mailing Address - Phone:212-684-3307
Mailing Address - Fax:
Practice Address - Street 1:160 E 34TH ST
Practice Address - Street 2:LL I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356483275OtherNPI 1356483275