Provider Demographics
NPI:1710011994
Name:SMITH, SANDRA LYNNETTE (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNNETTE
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 1:400 HWY 78 S.
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079
Mailing Address - Country:US
Mailing Address - Phone:731-253-9954
Mailing Address - Fax:
Practice Address - Street 1:400 HWY 78 S,
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079
Practice Address - Country:US
Practice Address - Phone:731-253-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000062482163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse