Provider Demographics
NPI:1972768828
Name:SMITH, DORIS O (LPN)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:O
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DORIS
Other - Middle Name:O
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3222 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-856-7500
Mailing Address - Fax:
Practice Address - Street 1:346 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1804
Practice Address - Country:US
Practice Address - Phone:716-856-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219350-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse