Provider Demographics
NPI:1447288600
Name:SMITH, MYRNA LEE (APN)
Entity type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24354 SHORTLY RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4909
Mailing Address - Country:US
Mailing Address - Phone:302-856-5225
Mailing Address - Fax:302-856-5061
Practice Address - Street 1:544 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1852
Practice Address - Country:US
Practice Address - Phone:302-856-5225
Practice Address - Fax:302-856-5061
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELF-0000101363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health