Provider Demographics
NPI:1730319765
Name:SMITH, NANCY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:SMITH
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 1:310 PITNEY LN UNIT 97
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-9677
Mailing Address - Country:US
Mailing Address - Phone:716-713-6126
Mailing Address - Fax:
Practice Address - Street 1:310 PITNEY LN UNIT 97
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-9677
Practice Address - Country:US
Practice Address - Phone:716-713-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292435164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse