Provider Demographics
NPI:1245796168
Name:FORREST-SMITH, SUZETTE (LPN)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:FORREST-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 1:950 E 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4608
Mailing Address - Country:US
Mailing Address - Phone:347-207-9603
Mailing Address - Fax:718-994-1279
Practice Address - Street 1:950 E 231ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4608
Practice Address - Country:US
Practice Address - Phone:347-207-9603
Practice Address - Fax:718-994-1279
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONOtherNON
NAOtherNA