Provider Demographics
NPI:1487901583
Name:SMITH, JEFFREY DEAN JR (LVN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DEAN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 W COLUMBIA WAY
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1104
Mailing Address - Country:US
Mailing Address - Phone:559-477-7965
Mailing Address - Fax:
Practice Address - Street 1:1782 W COLUMBIA WAY
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-1104
Practice Address - Country:US
Practice Address - Phone:559-477-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211288164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse