Provider Demographics
NPI:1780893099
Name:SMITH, LANA J (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 COTTAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1323 BROOKVILLE ST
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT CITY
Practice Address - State:PA
Practice Address - Zip Code:16224-1101
Practice Address - Country:US
Practice Address - Phone:814-275-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003329B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS47376Medicare UPIN
PA086221Medicare ID - Type Unspecified