Provider Demographics
NPI:1871855569
Name:SMITH, ANDRETTA JENE'
Entity Type:Individual
Prefix:
First Name:ANDRETTA
Middle Name:JENE'
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 1:11115 MILLS RD STE 114
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3036
Mailing Address - Country:US
Mailing Address - Phone:832-465-2512
Mailing Address - Fax:281-890-1884
Practice Address - Street 1:11115 MILLS RD STE 114
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3036
Practice Address - Country:US
Practice Address - Phone:832-465-2512
Practice Address - Fax:281-890-1884
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle