Provider Demographics
NPI:1710258488
Name:SMITH, MATTHEW G (APRN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2613
Mailing Address - Country:US
Mailing Address - Phone:603-448-1941
Mailing Address - Fax:603-448-6059
Practice Address - Street 1:252 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2613
Practice Address - Country:US
Practice Address - Phone:603-448-1941
Practice Address - Fax:603-448-6059
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH062214-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily