Provider Demographics
NPI:1760996375
Name:SMITH, CAROLYN SUE (MSN-RN-CNS-CWOCN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN-RN-CNS-CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2612
Mailing Address - Country:US
Mailing Address - Phone:765-660-6670
Mailing Address - Fax:765-671-3392
Practice Address - Street 1:441 N WABASH AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2612
Practice Address - Country:US
Practice Address - Phone:765-660-6670
Practice Address - Fax:765-671-3392
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28103859A163WE0900X, 163WW0000X, 364SC1501X, 163W00000X, 163WC2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care