Provider Demographics
NPI:1639280399
Name:SMITH, MONICA A (CFNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:A
Other - Last Name:SOFKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:2 ASTER DR
Mailing Address - Street 2:
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059-9613
Mailing Address - Country:US
Mailing Address - Phone:304-242-2439
Mailing Address - Fax:
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002285Medicaid
WV001718217OtherBCBS
WVSMNP18977Medicare PIN
WV3810002285Medicaid
WVSMNP18971Medicare PIN
WV001718217OtherBCBS