Provider Demographics
NPI:1912126285
Name:SMITH, LINDA M (APRN)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 OLD HWY
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3114
Mailing Address - Country:US
Mailing Address - Phone:203-210-5211
Mailing Address - Fax:
Practice Address - Street 1:51 OLD HWY
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3114
Practice Address - Country:US
Practice Address - Phone:203-970-1230
Practice Address - Fax:203-702-5004
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002669363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500000770Medicare ID - Type Unspecified
P48685Medicare UPIN