Provider Demographics
NPI:1356762629
Name:SMITH, SUSAN ELAINE (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
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 1:15 PEARL ST E
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1597
Mailing Address - Country:US
Mailing Address - Phone:607-561-7705
Mailing Address - Fax:607-563-9257
Practice Address - Street 1:15 PEARL ST E
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1597
Practice Address - Country:US
Practice Address - Phone:607-561-7705
Practice Address - Fax:607-563-9257
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse