Provider Demographics
NPI:1477614675
Name:SMYTH, JOAN KATHLEEN (MSN RN)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:KATHLEEN
Last Name:SMYTH
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 CHELSEA ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149
Mailing Address - Country:US
Mailing Address - Phone:781-388-6244
Mailing Address - Fax:781-388-6240
Practice Address - Street 1:173 CHELSEA ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:781-388-6244
Practice Address - Fax:781-388-6240
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105254163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0721Medicare ID - Type Unspecified