Provider Demographics
NPI:1659520757
Name:SMART-HOWARD, SUSAN JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JEAN
Last Name:SMART-HOWARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:697 BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7305
Mailing Address - Country:US
Mailing Address - Phone:802-879-1643
Mailing Address - Fax:
Practice Address - Street 1:697 BUTTERNUT RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7305
Practice Address - Country:US
Practice Address - Phone:802-879-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0008571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse