Provider Demographics
NPI:1174893457
Name:SMITH, SONJA JEAN (CNM)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR STE 280
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5974
Mailing Address - Country:US
Mailing Address - Phone:757-827-2455
Mailing Address - Fax:757-452-5773
Practice Address - Street 1:4000 COLISEUM DR STE 280
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5974
Practice Address - Country:US
Practice Address - Phone:757-827-2455
Practice Address - Fax:757-452-5773
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCNM0781207V00000X
VA0024173206363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000004517OtherTRICARE