Provider Demographics
NPI:1306197959
Name:SMITH, JONDA
Entity Type:Individual
Prefix:
First Name:JONDA
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 1:570 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3930
Mailing Address - Country:US
Mailing Address - Phone:402-917-7721
Mailing Address - Fax:
Practice Address - Street 1:570 W CHEYENNE AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3930
Practice Address - Country:US
Practice Address - Phone:402-917-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty