Provider Demographics
NPI:1477134864
Name:SMITH, MASCHIELLE ANN
Entity Type:Individual
Prefix:MS
First Name:MASCHIELLE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MASCHIELLE
Other - Middle Name:ANN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 EAST WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533
Mailing Address - Country:US
Mailing Address - Phone:608-553-1937
Mailing Address - Fax:
Practice Address - Street 1:310 EAST WALNUT ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533
Practice Address - Country:US
Practice Address - Phone:608-553-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care