Provider Demographics
NPI:1093157943
Name:SMITH, SHORNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHORNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 LEFFERTS AVE
Mailing Address - Street 2:APT F9
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1021
Mailing Address - Country:US
Mailing Address - Phone:347-608-7495
Mailing Address - Fax:
Practice Address - Street 1:621 LEFFERTS AVE
Practice Address - Street 2:APT F9
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1021
Practice Address - Country:US
Practice Address - Phone:347-608-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314324-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse