Provider Demographics
NPI:1407369101
Name:SMITH, NANNETTE (APN-C)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EVES DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3135
Mailing Address - Country:US
Mailing Address - Phone:856-596-1600
Mailing Address - Fax:
Practice Address - Street 1:5 EVES DR STE 300
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3135
Practice Address - Country:US
Practice Address - Phone:856-596-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00740900363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology