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General NPI Number Information
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NPI Number | 1255609293
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Entity Type | Individual
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Provider Name | SARA ROSE SMITH LPN
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Gender | Female
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 5511 STATE ROUTE 55
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City | LIBERTY
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State | NY
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Zip | 12754-2832
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Country | US
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Telephone | 865-719-3060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 913 120 MAIN ST APT 2
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City | LIVINGSTON MANOR
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State | NY
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Zip | 12758
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Country | US
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Telephone | 865-719-3060
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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 | 290440
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License Number State | NY
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