Provider Demographics
NPI:1891990610
Name:SMITH, EMILY J (PA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:PETERNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 W BELTLINE HWY STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2319
Practice Address - Country:US
Practice Address - Phone:608-287-2434
Practice Address - Fax:608-287-2182
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2161363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical