Provider Demographics
NPI:1497845515
Name:SMITH, MARCIA RENEE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 MCNARY BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-2737
Mailing Address - Country:US
Mailing Address - Phone:412-242-6631
Mailing Address - Fax:
Practice Address - Street 1:90 W CHESTNUT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4524
Practice Address - Country:US
Practice Address - Phone:724-228-7113
Practice Address - Fax:724-228-8587
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP000939G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASM388507OtherHIGHMARK
PA1991407OtherHIGHMARK