MEDICARE: MRS. SUZANNE C. SMITH RN BSN NCSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	274339-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184922577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE C. SMITH RN BSN NCSN

Provider Business Mailing Address
First Line	:	215 SOUTH BROAD STREET
Second Line	:
City	:	SACKETS HARBOR
State	:	NY
Zip	:	13685-0290
Country	:	US
Telephone Number	:	315-646-3419
Fax Number	:	315-646-1038

Provider Business Practice Location Address
First Line	:	215 SOUTH BROAD STREET
Second Line	:
City	:	SACKETS HARBOR
State	:	NY
Zip	:	13685-0290
Country	:	US
Telephone Number	:	315-646-3419
Fax Number	:	315-646-1038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	03/09/2011

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