Provider Demographics
NPI:1174846299
Name:SMITHERMAN, GENEVA LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:LYNN
Last Name:SMITHERMAN
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 1:24B ADLER PL
Mailing Address - Street 2:TH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3904
Mailing Address - Country:US
Mailing Address - Phone:718-671-1023
Mailing Address - Fax:347-326-5197
Practice Address - Street 1:508 AIRPORT EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5238
Practice Address - Country:US
Practice Address - Phone:845-425-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY46702164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse