Provider Demographics
NPI:1164734497
Name:SMITH, LAURA J (RN, MSN, CDE)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, MSN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:LOURDES DIABETES CENTER
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-772-6269
Mailing Address - Fax:607-771-6280
Practice Address - Street 1:169 RIVERSIDE DR
Practice Address - Street 2:LOURDES DIABETES CENTER
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-772-6269
Practice Address - Fax:607-771-6280
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY361393-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator