1609822972 NPI number — SHARON LORAINE SMITH FNP

Table of content: SHARON LORAINE SMITH FNP (NPI 1609822972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609822972 NPI number — SHARON LORAINE SMITH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SHARON
Provider Middle Name:
LORAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609822972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7309 SENECA N MEDICAL OFFICE BULDG SUITE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORNELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14843-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-385-3700
Provider Business Mailing Address Fax Number:
607-385-3600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORNELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14843-1933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-281-1970
Provider Business Practice Location Address Fax Number:
607-281-1969
Provider Enumeration Date:
05/26/2006

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: 363LF0000X , with the licence number:  331635 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: F331635-1 , 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)

  • Identifier: 01731933 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109466BF . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 500002120 . This is a "MEDICARE PIN RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005606041 . This is a "BC/BS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P019331635 . This is a "BLUE CHOICE EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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