Individual
LAVON LASHANDA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
115 S CEDAR AVE, MAPLE SHADE, NJ 08052-1711
(856) 571-3312
Mailing address
115 S CEDAR AVE # LEVEL1, MAPLE SHADE, NJ 08052-1711
(856) 571-3312
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR18139900
NJ
163W00000X
Registered Nurse
RN681687
PA
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508372897
—
NJ
Enumeration date
12/21/2017
Last updated
01/10/2022
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