Provider Demographics
NPI:1871835587
Name:SMITH, JENNIFER M (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
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 1:306 TWIN ELMS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1334
Mailing Address - Country:US
Mailing Address - Phone:315-432-5636
Mailing Address - Fax:
Practice Address - Street 1:306 TWIN ELMS LN
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1334
Practice Address - Country:US
Practice Address - Phone:315-432-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27424-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse