Provider Demographics
NPI:1780760736
Name:SMITH, DIANE CARMELLA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CARMELLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 SPRING LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-1616
Mailing Address - Country:US
Mailing Address - Phone:410-939-5511
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 19H, MEDICAL SERVICE, 111, AVENUE D
Practice Address - Street 2:
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:410-642-1898
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDRO37786363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health