Provider Demographics
NPI:1851825400
Name:SMITH, NATHANAEL ELIJAH (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:NATHANAEL
Middle Name:ELIJAH
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CAPITAL WAY STE 456
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-537-7300
Mailing Address - Fax:609-537-7301
Practice Address - Street 1:2 CAPITAL WAY
Practice Address - Street 2:SUITE 456
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-537-7300
Practice Address - Fax:609-537-7301
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9344864163WH0500X
CA95132000948163WH0500X
OR201241459RN163WH0500X
WARN60506695163WH0500X
NY725822163WH0500X
NJ26NR19208100163WH0500X
TXT196342163WH0500X
NJ26NJ00731900363L00000X
NJ26NJ19208100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner