Individual
TAVAURA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
703 KOSSUTH ST, BRIDGEPORT, CT 06608-1906
(203) 969-4418
Mailing address
703 KOSSUTH ST, BRIDGEPORT, CT 06608-1906
(203) 969-4418
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
044132
CT
164W00000X
Licensed Practical Nurse
Primary
344624
NY
Other
Enumeration date
05/15/2023
Last updated
05/15/2023
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