1487074753 NPI number — ELIZABETH FAE SMITH MS, RD, LDN, CNSC

Table of content: MRS. CORINNE PATRICIA FRANKS C.O.T.A/L (NPI 1356518773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487074753 NPI number — ELIZABETH FAE SMITH MS, RD, LDN, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
ELIZABETH
Provider Middle Name:
FAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487074753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
931 IDLEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARNEGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15106-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-638-6986
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15220-5532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-347-1786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN004896 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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