Provider Demographics
NPI:1770650749
Name:SMITH, DENENE P (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DENENE
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:2002 N CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3926
Mailing Address - Country:US
Mailing Address - Phone:910-272-3048
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:923 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9628
Practice Address - Country:US
Practice Address - Phone:910-775-9027
Practice Address - Fax:910-521-8091
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004147Medicaid
NC7004147Medicaid