Provider Demographics
NPI:1154652386
Name:SMITH, CATRINA (LPN,CRCFA)
Entity type:Individual
Prefix:
First Name:CATRINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN,CRCFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 RIVER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-9133
Mailing Address - Country:US
Mailing Address - Phone:864-205-7692
Mailing Address - Fax:
Practice Address - Street 1:240 RIVER FOREST DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-9133
Practice Address - Country:US
Practice Address - Phone:864-205-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP26156372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion