Provider Demographics
NPI:1083287445
Name:BLONDIN-SMITH, LORRAINE (RN)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BLONDIN-SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:CHRISTANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9945 GREAT SKUA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6377
Mailing Address - Country:US
Mailing Address - Phone:916-896-0566
Mailing Address - Fax:
Practice Address - Street 1:9945 GREAT SKUA WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6377
Practice Address - Country:US
Practice Address - Phone:916-896-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445645163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management