Provider Demographics
NPI:1942457296
Name:SMITH, PATRICIA JOAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOAN
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 1:3107 CONSEAR RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9660
Mailing Address - Country:US
Mailing Address - Phone:734-854-3773
Mailing Address - Fax:734-854-6448
Practice Address - Street 1:3107 CONSEAR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9660
Practice Address - Country:US
Practice Address - Phone:734-854-3773
Practice Address - Fax:734-854-6448
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 049507164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse