Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | F345477 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 345477 | NY |
NPI | 1003420472 |
---|---|
Provider Name | Mrs. Theodean Smith-Lawrence |
First Address | Rye Brook, NY 10573-1369 |
Second Address | White Plains, NY 10604-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 26/03/2021 |