Provider Demographics
NPI:1407594013
Name:SMITH, LUDISIA
Entity Type:Individual
Prefix:
First Name:LUDISIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 METROPOLITAN OVAL APT 8B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6526
Mailing Address - Country:US
Mailing Address - Phone:347-613-7423
Mailing Address - Fax:
Practice Address - Street 1:5 METROPOLITAN OVAL APT 8B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6526
Practice Address - Country:US
Practice Address - Phone:347-613-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222488164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse