Provider Demographics
NPI:1659694131
Name:SMOKEY, MARY KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:SMOKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2809
Mailing Address - Country:US
Mailing Address - Phone:608-223-6521
Mailing Address - Fax:
Practice Address - Street 1:5217 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-2809
Practice Address - Country:US
Practice Address - Phone:608-223-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310624031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse