Provider Demographics
NPI:1265242879
Name:GRESHAM-SMOTHERS, YVELL (LPN)
Entity type:Individual
Prefix:
First Name:YVELL
Middle Name:
Last Name:GRESHAM-SMOTHERS
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 1:618 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1613
Mailing Address - Country:US
Mailing Address - Phone:757-218-4794
Mailing Address - Fax:
Practice Address - Street 1:618 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1613
Practice Address - Country:US
Practice Address - Phone:757-218-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002085787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse