Provider Demographics
NPI:1982065363
Name:SMITH, NINA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11597 NEWBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8607
Mailing Address - Country:US
Mailing Address - Phone:317-582-0393
Mailing Address - Fax:
Practice Address - Street 1:11597 NEWBRIDGE CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8607
Practice Address - Country:US
Practice Address - Phone:317-582-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist