Provider Demographics
NPI:1326221938
Name:SMITH, LADONNA MARIE
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:MARIE
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:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-1300
Mailing Address - Country:US
Mailing Address - Phone:304-564-3411
Mailing Address - Fax:304-564-3990
Practice Address - Street 1:195 GOLDEN BEAR DR
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-1672
Practice Address - Country:US
Practice Address - Phone:304-564-3411
Practice Address - Fax:304-564-3990
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42562163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009014Medicaid