Provider Demographics
NPI:1871680694
Name:SMITH, LORRAINE M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:M
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-233-9700
Mailing Address - Fax:215-233-9710
Practice Address - Street 1:1722 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1644
Practice Address - Country:US
Practice Address - Phone:215-233-9700
Practice Address - Fax:215-233-9710
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005401B363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAUP005401BOtherCRNP LICENSE