Provider Demographics
NPI:1376632992
Name:SMITH, CHARLENE M (DNSC MSED WHNP BC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNSC MSED WHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 LAURA LANE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420
Mailing Address - Country:US
Mailing Address - Phone:585-341-6805
Mailing Address - Fax:585-341-0433
Practice Address - Street 1:120 LAURA LANE
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420
Practice Address - Country:US
Practice Address - Phone:585-341-6805
Practice Address - Fax:585-341-0433
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420402363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health