Provider Demographics
NPI:1396041620
Name:SMITH-BECKFORD, MICKELIA TIOMI THERESA
Entity type:Individual
Prefix:
First Name:MICKELIA
Middle Name:TIOMI THERESA
Last Name:SMITH-BECKFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21604 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1201
Mailing Address - Country:US
Mailing Address - Phone:347-339-4983
Mailing Address - Fax:
Practice Address - Street 1:21604 130TH AVE
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1201
Practice Address - Country:US
Practice Address - Phone:347-531-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3035231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse