Provider Demographics
NPI:1144673534
Name:SMITH, JANEL
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 DEAN ST
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2916
Mailing Address - Country:US
Mailing Address - Phone:917-499-6530
Mailing Address - Fax:
Practice Address - Street 1:1075 DEAN ST
Practice Address - Street 2:#3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2916
Practice Address - Country:US
Practice Address - Phone:917-499-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668984163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse