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General NPI Number Information
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NPI Number | 1235959669
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Entity Type | Individual
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Provider Name | CANDY L SMITH
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Gender | Female
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 650 STATE ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2839
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Country | US
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Telephone | 315-755-1251
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Fax | 315-291-6601
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Provider Business Mailing Address
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Address Line | PO BOX 608
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City | MALONE
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State | NY
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Zip | 12953-0608
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Country | US
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Telephone | 518-651-2302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 330129-01
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License Number State | NY
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