Provider Demographics
NPI:1932475225
Name:SMITH, DAVIOT IAN CLUNES (RN)
Entity Type:Individual
Prefix:MR
First Name:DAVIOT
Middle Name:IAN CLUNES
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 MACDONOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1007
Mailing Address - Country:US
Mailing Address - Phone:718-573-4206
Mailing Address - Fax:
Practice Address - Street 1:272 MACDONOUGH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1007
Practice Address - Country:US
Practice Address - Phone:718-573-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466897163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool