1245691500 NPI number — ANNA VICTORIA SMITH MS, RDN, LDN

Table of content: ANNA VICTORIA SMITH MS, RDN, LDN (NPI 1245691500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245691500 NPI number — ANNA VICTORIA SMITH MS, RDN, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
ANNA
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RDN, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAFUNNO
Provider Other First Name:
ANNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245691500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 ELM HILL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37214-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-425-4211
Provider Business Mailing Address Fax Number:
615-425-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7087 HIGHWAY 70 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37221-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-393-6490
Provider Business Practice Location Address Fax Number:
615-393-6491
Provider Enumeration Date:
03/15/2016

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:  3017 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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