Provider Demographics
NPI:1063788354
Name:SMITH, MABLE HAMILTON (RN)
Entity type:Individual
Prefix:
First Name:MABLE
Middle Name:HAMILTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1598 JUNIPER TWIG AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7117
Mailing Address - Country:US
Mailing Address - Phone:702-300-4827
Mailing Address - Fax:702-968-1645
Practice Address - Street 1:11 SUNSET WAY
Practice Address - Street 2:COLLEGE OF NURSING
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2333
Practice Address - Country:US
Practice Address - Phone:702-986-2021
Practice Address - Fax:702-968-1645
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN46712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse