Provider Demographics
NPI:1164289799
Name:SMITH, NICOLE RAMONA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RAMONA
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 1:9804 GLEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4416
Mailing Address - Country:US
Mailing Address - Phone:202-558-8990
Mailing Address - Fax:
Practice Address - Street 1:2301 11TH ST NW APT 418
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2257
Practice Address - Country:US
Practice Address - Phone:202-488-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant