Provider Demographics
NPI:1609467950
Name:SMITH, AMY MICHIKO
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHIKO
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHIKO
Other - Last Name:PACREM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-2486
Mailing Address - Country:US
Mailing Address - Phone:702-467-2011
Mailing Address - Fax:
Practice Address - Street 1:830 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2486
Practice Address - Country:US
Practice Address - Phone:702-467-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant