Individual
MRS. EBONY M. SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
328 INTERCHANGE DR, FAYETTEVILLE, NC 28311-7417
(910) 964-5642
Mailing address
328 INTERCHANGE DR, FAYETTEVILLE, NC 28311-7417
(910) 964-5642
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
280956-1
NY
164W00000X
Licensed Practical Nurse
Primary
73712
NC
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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