Provider Demographics
NPI:1508577941
Name:SMITH, MAYGAN LEE (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:MAYGAN
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2632
Mailing Address - Country:US
Mailing Address - Phone:937-271-4022
Mailing Address - Fax:
Practice Address - Street 1:119 W 2ND ST APT 313
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3564
Practice Address - Country:US
Practice Address - Phone:937-271-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health