MEDICARE: MRS. PATRICKA S ATKINSON -SMITH

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	2640921	NY

General Provider Information

NPI Number	:	1477911055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICKA S ATKINSON -SMITH

Provider Business Mailing Address
First Line	:	18 LAWRENCE ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5038
Country	:	US
Telephone Number	:	845-596-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 LAWRENCE ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5038
Country	:	US
Telephone Number	:	184-559-6465
Fax Number	:

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	05/01/2017

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