Provider Demographics
NPI:1215396718
Name:SMITH, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0037
Mailing Address - Country:US
Mailing Address - Phone:985-624-4100
Mailing Address - Fax:985-624-4125
Practice Address - Street 1:23363 SOUTH ROBIN RD
Practice Address - Street 2:MANDEVILLE
Practice Address - City:LOUISIANA
Practice Address - State:LA
Practice Address - Zip Code:70470-0037
Practice Address - Country:US
Practice Address - Phone:985-624-4100
Practice Address - Fax:985-624-4125
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA242522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse