Provider Demographics
NPI:1053051284
Name:SMITH, MARILYN DENISE (CNA, PCA, LA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA, PCA, LA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2050
Mailing Address - Country:US
Mailing Address - Phone:469-612-3766
Mailing Address - Fax:469-779-6739
Practice Address - Street 1:1005 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2050
Practice Address - Country:US
Practice Address - Phone:469-612-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376K00000X
TXNA0010345478374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide