Provider Demographics
NPI:1174339329
Name:SMITH, RENEE C (RN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FAIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4111
Mailing Address - Country:US
Mailing Address - Phone:631-255-6880
Mailing Address - Fax:
Practice Address - Street 1:20 FAIRLINE DR
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-4111
Practice Address - Country:US
Practice Address - Phone:631-255-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY94743101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse