Provider Demographics
NPI:1083215750
Name:SMITH, ANNA LISA
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LISA
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 1:399 MEACHAM RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:OH
Mailing Address - Zip Code:45672-9610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:399 MEACHAM RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:OH
Practice Address - Zip Code:45672-9610
Practice Address - Country:US
Practice Address - Phone:740-286-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker