Provider Demographics
NPI:1851161384
Name:SMITH, EMMA SHAWNTEL
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:SHAWNTEL
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 1:3154 FULMER RD APT 206
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4723
Mailing Address - Country:US
Mailing Address - Phone:440-453-9876
Mailing Address - Fax:
Practice Address - Street 1:3154 FULMER RD APT 206
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4723
Practice Address - Country:US
Practice Address - Phone:440-453-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker