Provider Demographics
NPI:1518382035
Name:SMITH, MYNA ELIZABETH (CNM)
Entity Type:Individual
Prefix:
First Name:MYNA
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 LULL WATER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4520
Mailing Address - Country:US
Mailing Address - Phone:757-450-9414
Mailing Address - Fax:
Practice Address - Street 1:2301 ROBESON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5640
Practice Address - Country:US
Practice Address - Phone:910-485-1191
Practice Address - Fax:910-485-6006
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCCNM#534367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife