MEDICARE: MS. VERA SMITH LPN

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	164W00000X	Licensed Practical Nurse	311582	NY

General Provider Information

NPI Number	:	1275884801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VERA SMITH LPN

Provider Business Mailing Address
First Line	:	19 TUTHILL POINT RD
Second Line	:
City	:	EAST MORICHES
State	:	NY
Zip	:	11940-1216
Country	:	US
Telephone Number	:	631-220-6031
Fax Number	:	631-846-6665

Provider Business Practice Location Address
First Line	:	19 TUTHILL POINT RD
Second Line	:
City	:	EAST MORICHES
State	:	NY
Zip	:	11940-1216
Country	:	US
Telephone Number	:	631-220-6031
Fax Number	:	631-846-6665

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

Provider Enumeration Date	:	09/22/2012
Last Update Date	:	09/22/2012

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