Provider Demographics
NPI:1245504612
Name:SMITH, LINDSEY ALISE (RN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ALISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1314
Mailing Address - Country:US
Mailing Address - Phone:860-763-0652
Mailing Address - Fax:
Practice Address - Street 1:736 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1314
Practice Address - Country:US
Practice Address - Phone:860-763-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104374163W00000X
MARN2278635163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse