Basic Information
| Provider Information | |||||||||
| NPI: | 1104102623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | RN, BC, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1909 DELLWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274086201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366413630 | ||||||||
| FaxNumber: | 3366417761 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N EUGENE ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274012221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366413630 | ||||||||
| FaxNumber: | 3366417761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2011 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 64155 | NC | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 64155 | 01 | NC | LICENSE | OTHER |