Provider Demographics
NPI:1912374067
Name:SMITH, LAURA D (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:D
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 1:1025 W HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-4848
Mailing Address - Country:US
Mailing Address - Phone:717-944-0491
Mailing Address - Fax:717-944-1436
Practice Address - Street 1:1025 W HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-4848
Practice Address - Country:US
Practice Address - Phone:717-944-0491
Practice Address - Fax:717-944-1436
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015273363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103065899Medicaid
PA103065899Medicaid