Provider Demographics
NPI:1083454169
Name:SMITH, BRISHAE CHARLESE (LPN)
Entity type:Individual
Prefix:
First Name:BRISHAE
Middle Name:CHARLESE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7537
Mailing Address - Country:US
Mailing Address - Phone:585-784-0247
Mailing Address - Fax:
Practice Address - Street 1:38 KANSAS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7537
Practice Address - Country:US
Practice Address - Phone:585-784-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336825-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse