Individual
CANDY L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 STATE ST, WATERTOWN, NY 13601-2839
(315) 755-1251
(315) 291-6601
Mailing address
PO BOX 608, MALONE, NY 12953-0608
(518) 651-2302
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
330129-01
NY
Other
Enumeration date
10/11/2024
Last updated
10/11/2024
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