Provider Demographics
NPI:1225815871
Name:SMITH, MICHELLE ANNETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNETTE
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 1:102 SMITH EXTENSION RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:WV
Mailing Address - Zip Code:24726-8103
Mailing Address - Country:US
Mailing Address - Phone:765-717-1704
Mailing Address - Fax:
Practice Address - Street 1:102 SMITH EXTENSION RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:WV
Practice Address - Zip Code:24726-8103
Practice Address - Country:US
Practice Address - Phone:765-717-1704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant