Provider Demographics
NPI:1659899557
Name:SMITH, LANITA MARCHEL
Entity Type:Individual
Prefix:
First Name:LANITA
Middle Name:MARCHEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANITA
Other - Middle Name:MARCHEL
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-0414
Mailing Address - Country:US
Mailing Address - Phone:240-743-6668
Mailing Address - Fax:
Practice Address - Street 1:12308 JAMES MADISON LN
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9169
Practice Address - Country:US
Practice Address - Phone:240-743-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant