Provider Demographics
NPI:1427874163
Name:SMOSNA, JACLYN MAUREEN (LVN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MAUREEN
Last Name:SMOSNA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95536-0224
Mailing Address - Country:US
Mailing Address - Phone:707-683-9549
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 224
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:CA
Practice Address - Zip Code:95536-0224
Practice Address - Country:US
Practice Address - Phone:707-683-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA717433164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse