Provider Demographics
NPI:1407125438
Name:SMITH, STEFANIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-3900
Mailing Address - Country:US
Mailing Address - Phone:518-668-5714
Mailing Address - Fax:518-668-5876
Practice Address - Street 1:69 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3900
Practice Address - Country:US
Practice Address - Phone:518-668-5714
Practice Address - Fax:518-668-5876
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342052163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool