Provider Demographics
NPI:1013947175
Name:SMITH, MARY ARMINTA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ARMINTA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ARMINTA
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-855-3464
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001068677163W00000X
VA0024068677367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse