Provider Demographics
NPI:1225588403
Name:SMITH, LAURIE (RNFA RN FIRST ASSIST)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RNFA RN FIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SCHOELLKOPF RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9520
Mailing Address - Country:US
Mailing Address - Phone:716-860-7740
Mailing Address - Fax:
Practice Address - Street 1:1400 SCHOELLKOPF RD
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:NY
Practice Address - Zip Code:14085-9520
Practice Address - Country:US
Practice Address - Phone:716-860-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431331163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant