Provider Demographics
NPI:1467925073
Name:SMITH, CHARLOTTE RENAE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:RENAE
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 1:21444 E N RAILROAD
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940
Mailing Address - Country:US
Mailing Address - Phone:918-658-3666
Mailing Address - Fax:918-658-2333
Practice Address - Street 1:21444 E N RAILROAD
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:OK
Practice Address - Zip Code:74940
Practice Address - Country:US
Practice Address - Phone:918-658-3666
Practice Address - Fax:918-658-2333
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant