Provider Demographics
NPI:1356646442
Name:SMITH, NANCY CATHERINE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CATHERINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:CRABTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2304 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2856
Mailing Address - Country:US
Mailing Address - Phone:618-462-8655
Mailing Address - Fax:
Practice Address - Street 1:4251 FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2810
Practice Address - Country:US
Practice Address - Phone:314-531-7526
Practice Address - Fax:314-533-1586
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037947363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health