Provider Demographics
NPI:1700542990
Name:SMITH, SYDNEY MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:MARIE
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:W9228 FORESTED RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9558
Mailing Address - Country:US
Mailing Address - Phone:608-209-1100
Mailing Address - Fax:
Practice Address - Street 1:W9228 FORESTED RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-9558
Practice Address - Country:US
Practice Address - Phone:608-209-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI326276-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse