Provider Demographics
NPI:1003420472
Name:SMITH-LAWRENCE, THEODEAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:THEODEAN
Middle Name:
Last Name:SMITH-LAWRENCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WESTCHESTER AVE STE N715
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1369
Mailing Address - Country:US
Mailing Address - Phone:914-607-5730
Mailing Address - Fax:
Practice Address - Street 1:210 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2901
Practice Address - Country:US
Practice Address - Phone:914-681-3100
Practice Address - Fax:914-682-6588
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345477208D00000X
NY345477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF345477Medicaid