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Individual

JENNIFER ROMAINE SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
19 FOREST LN, CORAM, NY 11727-3140
(631) 375-3005
Mailing address
835 BROADWAY AVE APT 16B, HOLBROOK, NY 11741-4925
(631) 375-3005

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
701898
NY
163WH0200X
Home Health Registered Nurse
Primary
701898
NY
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
701898
NY
163WP0808X
Psychiatric/Mental Health Registered Nurse
701898
NY
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
701898
NY

Other

Enumeration date
08/27/2018
Last updated
11/08/2021
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