Provider Demographics
NPI:1376862003
Name:SMITH, CLIFFORD W (CRNP)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DELAFIELD RD STE 4010
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3235
Mailing Address - Country:US
Mailing Address - Phone:412-784-5770
Mailing Address - Fax:412-784-5776
Practice Address - Street 1:200 DELAFIELD RD STE 4010
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3235
Practice Address - Country:US
Practice Address - Phone:412-784-5770
Practice Address - Fax:412-784-5776
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner