Provider Demographics
NPI:1396074860
Name:SMITH, MARY STUTZMAN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:STUTZMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44260 NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3390
Mailing Address - Country:US
Mailing Address - Phone:703-408-0911
Mailing Address - Fax:
Practice Address - Street 1:44260 NAVAJO DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3390
Practice Address - Country:US
Practice Address - Phone:703-408-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula