Provider Demographics
NPI:1841409919
Name:SMITH, AUTUMN BLAIR (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:BLAIR
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 007
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-0953
Mailing Address - Fax:610-869-5824
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 007
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-0953
Practice Address - Fax:610-869-5824
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DELZ0000111363LA2100X
PASP010920363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care