Provider Demographics
NPI:1972892719
Name:SMITH, DEBORAH NINA (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:NINA
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 1:415 WEST LINCOLN AVE
Mailing Address - Street 2:PO BOX 478
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-0478
Mailing Address - Country:US
Mailing Address - Phone:301-447-2083
Mailing Address - Fax:
Practice Address - Street 1:6000 CULLEN DRIVE
Practice Address - Street 2:
Practice Address - City:SABILLASVILLE
Practice Address - State:MD
Practice Address - Zip Code:21780
Practice Address - Country:US
Practice Address - Phone:301-739-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2009005127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily