Provider Demographics
NPI:1043927619
Name:SMITH, SUEANNA C
Entity Type:Individual
Prefix:
First Name:SUEANNA
Middle Name:C
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 1:820 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1530
Mailing Address - Country:US
Mailing Address - Phone:304-453-4992
Mailing Address - Fax:
Practice Address - Street 1:820 POPLAR ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1530
Practice Address - Country:US
Practice Address - Phone:304-453-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health