Provider Demographics
NPI:1619523800
Name:SMITH, LAUREN E (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2697 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1701
Mailing Address - Country:US
Mailing Address - Phone:585-371-8373
Mailing Address - Fax:716-831-1065
Practice Address - Street 1:114 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2929
Practice Address - Country:US
Practice Address - Phone:585-371-8373
Practice Address - Fax:716-831-1065
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344490363LF0000X
NY344490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty