Provider Demographics
NPI:1063607786
Name:SMITH, LAURA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:KELSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2705 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3111
Mailing Address - Country:US
Mailing Address - Phone:607-286-7171
Mailing Address - Fax:
Practice Address - Street 1:2705 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3111
Practice Address - Country:US
Practice Address - Phone:607-286-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263244-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse