Provider Demographics
NPI:1598395295
Name:SMITH, DALE ANDREA
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:ANDREA
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 1:216 RAILWAY ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL FALL
Mailing Address - State:MI
Mailing Address - Zip Code:49920
Mailing Address - Country:US
Mailing Address - Phone:906-282-2547
Mailing Address - Fax:
Practice Address - Street 1:216 RAILWAY ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALL
Practice Address - State:MI
Practice Address - Zip Code:49920
Practice Address - Country:US
Practice Address - Phone:906-282-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider