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NPI Code Detail

MEDICARE: LENA SMITH RN

MEDICARE: LENA SMITH RN
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
1163WS0200XSchool Registered Nurse55669SC

General Provider Information

NPI Number : 1225754823
Entity Type Code : Individual
Provider Name (Legal Business Name) : LENA SMITH RN
Provider Business Mailing Address
First Line : PO BOX 1569
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-1569
Country : US
Telephone Number : 843-374-3321
Fax Number :
Provider Business Practice Location Address
First Line : 652 N MATTHEWS RD
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-7008
Country : US
Telephone Number : 843-374-3321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2022
Last Update Date : 10/14/2022

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