Basic Information
| Provider Information | |||||||||
| NPI: | 1285069112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 725 | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133260725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6076742445 | ||||||||
| FaxNumber: | 6076744338 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | SHERBURNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6076742445 | ||||||||
| FaxNumber: | 6076744338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2013 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
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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 | 363LF0000X | 338084 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.