Provider Demographics
NPI:1346964905
Name:MANGERIAN-SMITH, LAURA ANN (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MANGERIAN-SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MANGERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:23 KIRKLEES RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1557
Mailing Address - Country:US
Mailing Address - Phone:585-298-4757
Mailing Address - Fax:
Practice Address - Street 1:211 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9711
Practice Address - Country:US
Practice Address - Phone:585-421-2157
Practice Address - Fax:585-421-8722
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY398653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty