Provider Demographics
NPI:1669719191
Name:SMITH, JENNIFER (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
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 1:500 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-9004
Mailing Address - Country:US
Mailing Address - Phone:803-568-1100
Mailing Address - Fax:803-568-1117
Practice Address - Street 1:500 E FIRST ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-9004
Practice Address - Country:US
Practice Address - Phone:803-568-1100
Practice Address - Fax:803-568-1117
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP31276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse