Provider Demographics
NPI:1609484963
Name:SMITH, LADONNA MARIE
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:MARIE
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 1:12611 NE 99TH ST APT H50
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2480
Mailing Address - Country:US
Mailing Address - Phone:503-875-8346
Mailing Address - Fax:
Practice Address - Street 1:6224 N ASTOR ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-1302
Practice Address - Country:US
Practice Address - Phone:503-875-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula