Provider Demographics
NPI:1508138413
Name:SMITH, VICKI LYNN (MS, RN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:SMITH
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Gender:F
Credentials:MS, RN, WHNP-BC
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Mailing Address - Street 1:5300 MILITARY RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1903
Mailing Address - Country:US
Mailing Address - Phone:716-298-2760
Mailing Address - Fax:716-298-2760
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-298-2760
Practice Address - Fax:716-298-2760
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
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Provider Licenses
StateLicense IDTaxonomies
NYF420604-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health