Provider Demographics
NPI:1689145179
Name:SMITH, ERIN KATHLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 STATE ROUTE 63
Mailing Address - Street 2:HIGH SCHOOL
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9404
Mailing Address - Country:US
Mailing Address - Phone:585-728-2366
Mailing Address - Fax:
Practice Address - Street 1:2350 STATE ROUTE 63
Practice Address - Street 2:HIGH SCHOOL
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9404
Practice Address - Country:US
Practice Address - Phone:585-728-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718466-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY355Medicaid