Healthcare Provider Details

I. General information

NPI: 1619523800
Provider Name (Legal Business Name): LAUREN E. SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN E BURKE NP

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 UNIVERSITY AVE
ROCHESTER NY
14605-2929
US

IV. Provider business mailing address

2697 MAIN ST
BUFFALO NY
14214-1701
US

V. Phone/Fax

Practice location:
  • Phone: 585-371-8373
  • Fax: 716-831-1065
Mailing address:
  • Phone: 585-371-8373
  • Fax: 716-831-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344490
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: