Provider Demographics
NPI:1174269401
Name:SMITH, BENITA
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:
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 1:3215 11TH PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5931
Mailing Address - Country:US
Mailing Address - Phone:202-230-9419
Mailing Address - Fax:202-885-9440
Practice Address - Street 1:3215 11TH PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5931
Practice Address - Country:US
Practice Address - Phone:202-230-9419
Practice Address - Fax:202-885-9440
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant