Provider Demographics
NPI:1659077873
Name:SMITH NWANIEMEKA, JEANETTE (CPMA)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:SMITH NWANIEMEKA
Suffix:
Gender:F
Credentials:CPMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 E PENN PINES BLVD # VD
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4310
Mailing Address - Country:US
Mailing Address - Phone:267-858-7514
Mailing Address - Fax:484-727-9378
Practice Address - Street 1:827 E PENN PINES BLVD # VD
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-4310
Practice Address - Country:US
Practice Address - Phone:267-858-7514
Practice Address - Fax:484-727-9378
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor