Provider Demographics
NPI:1285913376
Name:CARNO-SMITH, DEGUARDA (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEGUARDA
Middle Name:
Last Name:CARNO-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 1:3321 MICKLE AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2717
Mailing Address - Country:US
Mailing Address - Phone:718-547-8940
Mailing Address - Fax:
Practice Address - Street 1:3321 MICKLE AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2717
Practice Address - Country:US
Practice Address - Phone:718-547-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234497-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse