Provider Demographics
NPI:1609921824
Name:SMITH, ELIZABETH R D (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R D
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROGAL
Other - Last Name:DEPRINCE-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:204 MCCOLLUM ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5127
Mailing Address - Country:US
Mailing Address - Phone:307-314-4242
Mailing Address - Fax:307-460-3331
Practice Address - Street 1:204 MCCOLLUM ST STE 203
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5127
Practice Address - Country:US
Practice Address - Phone:307-314-4242
Practice Address - Fax:307-460-3331
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY295021116363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics