Provider Demographics
NPI:1003238288
Name:SMITH, DEBROSIA
Entity Type:Individual
Prefix:
First Name:DEBROSIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 FOX DOWER CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2923
Mailing Address - Country:US
Mailing Address - Phone:314-564-3860
Mailing Address - Fax:
Practice Address - Street 1:23 N OAKS PLZ STE 239
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-2996
Practice Address - Country:US
Practice Address - Phone:314-564-3860
Practice Address - Fax:314-653-6686
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health