Provider Demographics
NPI:1093409989
Name:SMITH, LORA MONIQUE (HHA)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:MONIQUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42600 NATIONAL RD LOT 21
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-9728
Mailing Address - Country:US
Mailing Address - Phone:740-298-0142
Mailing Address - Fax:
Practice Address - Street 1:42600 NATIONAL RD LOT 21
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:OH
Practice Address - Zip Code:43718-9728
Practice Address - Country:US
Practice Address - Phone:740-298-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide