Provider Demographics
NPI:1720113160
Name:SMITH, FRANCES JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
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 850
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0850
Mailing Address - Country:US
Mailing Address - Phone:219-987-7750
Mailing Address - Fax:219-987-5750
Practice Address - Street 1:519 N HALLECK
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-0850
Practice Address - Country:US
Practice Address - Phone:219-987-7750
Practice Address - Fax:219-987-5750
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000906A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
162910Medicare ID - Type Unspecified
R76846Medicare UPIN