Provider Demographics
NPI:1700029808
Name:SMITH, ANNAMARIA (GN)
Entity Type:Individual
Prefix:
First Name:ANNAMARIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:GN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12634 OLIVE BLVD
Mailing Address - Street 2:1 EAST
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6337
Mailing Address - Country:US
Mailing Address - Phone:314-704-0085
Mailing Address - Fax:
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:1 EAST
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-704-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program