Provider Demographics
NPI:1689181166
Name:SMITH, BRENDA L (APN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MERION AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEYS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-3409
Mailing Address - Country:US
Mailing Address - Phone:856-299-0345
Mailing Address - Fax:856-299-9438
Practice Address - Street 1:316 MERION AVE
Practice Address - Street 2:
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-3409
Practice Address - Country:US
Practice Address - Phone:856-299-0345
Practice Address - Fax:856-299-9438
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00788100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner