Provider Demographics
NPI:1457780785
Name:SMITH, DEBORAH (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:70 NORTH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1340
Mailing Address - Country:US
Mailing Address - Phone:607-437-3216
Mailing Address - Fax:
Practice Address - Street 1:70 NORTH ST APT 1
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1340
Practice Address - Country:US
Practice Address - Phone:607-437-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291762-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse