Provider Demographics
NPI:1033733514
Name:REDFIELD - SMITH, LATONIA NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:NICOLE
Last Name:REDFIELD - SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PINE KNOLL DR STE H5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3251
Mailing Address - Country:US
Mailing Address - Phone:864-363-6759
Mailing Address - Fax:864-263-7029
Practice Address - Street 1:44 PINE KNOLL DR STE H5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3251
Practice Address - Country:US
Practice Address - Phone:864-363-6759
Practice Address - Fax:864-263-7029
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide