Provider Demographics
NPI:1457623142
Name:SMITH, MBUYI MARIE-CLAIRE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MBUYI
Middle Name:MARIE-CLAIRE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MBUYI
Other - Middle Name:MARIE-CLAIRE
Other - Last Name:BUNDUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:192 TILLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4440
Mailing Address - Country:US
Mailing Address - Phone:802-847-4690
Mailing Address - Fax:
Practice Address - Street 1:192 TILLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4440
Practice Address - Country:US
Practice Address - Phone:802-847-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010083505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily