| NPI | 1104160589 |
|---|---|
| Former Name | STEPHANIE RAE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: CO TRA1-0437-3459) |
| Enumeration Date | 2012-11-25 |
| Last Update Date | 2022-09-29 |