Provider Demographics
NPI:1457794141
Name:SMITH, MARY E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:SMITH
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 1:719 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2517
Mailing Address - Country:US
Mailing Address - Phone:843-423-1811
Mailing Address - Fax:843-423-8328
Practice Address - Street 1:105 CHARLES ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-1801
Practice Address - Country:US
Practice Address - Phone:843-464-3750
Practice Address - Fax:843-464-3755
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP9461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse