1255540449 NPI number — MISS CARLENA MINORA SMITH REGISTERED NURSE

Table of content: MISS CARLENA MINORA SMITH REGISTERED NURSE (NPI 1255540449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255540449 NPI number — MISS CARLENA MINORA SMITH REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CARLENA
Provider Middle Name:
MINORA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
CARLENA
Provider Other Middle Name:
MINORA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255540449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 BRUCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10552-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-663-1845
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10601-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-682-1440
Provider Business Practice Location Address Fax Number:
914-682-1441
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  431263-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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