Provider Demographics
NPI:1558675439
Name:SMITH, ROSALIND L (RN629383)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN629383
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25743 148TH RD FL 1
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2915
Mailing Address - Country:US
Mailing Address - Phone:419-303-4385
Mailing Address - Fax:
Practice Address - Street 1:25743 148TH RD FL 1
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2915
Practice Address - Country:US
Practice Address - Phone:419-303-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY629383163W00000X
OH350200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse