Provider Demographics
NPI:1720565419
Name:SMITH, CAROL E (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:E
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 1:1623 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3454
Mailing Address - Country:US
Mailing Address - Phone:605-484-7090
Mailing Address - Fax:
Practice Address - Street 1:1623 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3454
Practice Address - Country:US
Practice Address - Phone:605-484-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR014517163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR014517OtherSD NURSING LICENSE