Provider Demographics
NPI:1255540449
Name:SMITH, CARLENA MINORA (REGISTERED NURSE)
Entity type:Individual
Prefix:MISS
First Name:CARLENA
Middle Name:MINORA
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:CARLENA
Other - Middle Name:MINORA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:111 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3014
Mailing Address - Country:US
Mailing Address - Phone:914-663-1845
Mailing Address - Fax:
Practice Address - Street 1:55 CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1905
Practice Address - Country:US
Practice Address - Phone:914-682-1440
Practice Address - Fax:914-682-1441
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431263-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse