Provider Demographics
NPI:1457687949
Name:WHITE-SMITH, ROXANNE (LVN, DSD, CPR INST)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:
Last Name:WHITE-SMITH
Suffix:
Gender:F
Credentials:LVN, DSD, CPR INST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-4443
Mailing Address - Country:US
Mailing Address - Phone:909-991-0331
Mailing Address - Fax:
Practice Address - Street 1:252 E TEMPLE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-4443
Practice Address - Country:US
Practice Address - Phone:909-991-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN210429164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN210429OtherLVN LICENSE NUMBER