Provider Demographics
NPI:1376788737
Name:SMITH, PATRICIA L (CHN 1)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:CHN 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STATE HIGHWAY 310
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1436
Mailing Address - Country:US
Mailing Address - Phone:315-386-2325
Mailing Address - Fax:315-386-2744
Practice Address - Street 1:80 SH 310
Practice Address - Street 2:SUITE 2
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1476
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:315-386-2744
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309376-1163WC1500X, 163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health