Provider Demographics
NPI:1780934547
Name:SMITH, NICOLE SUE (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ARTHURIAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1155
Mailing Address - Country:US
Mailing Address - Phone:810-275-5533
Mailing Address - Fax:
Practice Address - Street 1:41 ARTHURIAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514
Practice Address - Country:US
Practice Address - Phone:810-275-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22643611163W00000X
MI4704243926163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse