Provider Demographics
NPI:1508193921
Name:SMITH, SARAH L (CPNP, DNP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:925 CANTERBURY RD. NE #1242
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:AL
Practice Address - Zip Code:30324-7694
Practice Address - Country:US
Practice Address - Phone:404-228-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner