Most Relevant Information
Provider Data
| NPI Number: | 1003420472 |
| Provider Name: | THEODEAN SMITH-LAWRENCE FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 345477 |
Most Important Dates
| Enumeration Date: | 09/03/2020 |
| Last Updated: | 06/13/2024 |
Provider Practice Location
147 LAKE ST
NEWBURGH
NY
125505263
Practice Location Phone/Fax
| Phone: | 8455638000 |
| Fax: |
Provider Mailing Location
2570 ROUTE 9W STE 10
CORNWALL
NY
125181370
Provider Mailing Phone/Fax
| Phone: | 8452203100 |
| Fax: |