Provider Demographics
NPI:1720041734
Name:SMITH, CONSTANCE B (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEAVER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2434
Mailing Address - Country:US
Mailing Address - Phone:814-503-8070
Mailing Address - Fax:814-503-8531
Practice Address - Street 1:33 BEAVER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2434
Practice Address - Country:US
Practice Address - Phone:814-503-8070
Practice Address - Fax:814-503-8531
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003662B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01811352Medicaid
PAP09720Medicare UPIN
PA039292KNCMedicare ID - Type UnspecifiedHGSADMINISTRATORS