Provider Demographics
NPI:1801220660
Name:SMITH, STEPHANIE (LVN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MEMORIAL DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2177
Mailing Address - Country:US
Mailing Address - Phone:972-391-4252
Mailing Address - Fax:903-464-0559
Practice Address - Street 1:1105 MEMORIAL DR
Practice Address - Street 2:SUITE #101
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2177
Practice Address - Country:US
Practice Address - Phone:972-391-4252
Practice Address - Fax:903-464-0559
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308625164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse