Provider Demographics
NPI:1356531669
Name:SMITH, SHIRLEY L (RN APN)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MADISON AVE
Mailing Address - Street 2:M-WE0-01 STUDENT HEALTH
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-443-8535
Mailing Address - Fax:973-443-8174
Practice Address - Street 1:285 MADISON AVE
Practice Address - Street 2:M-WE0-01 STUDENT HEALTH
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-443-8535
Practice Address - Fax:973-443-8174
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO04975600163WC1400X
NJ26NN04975600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health