Provider Demographics
NPI:1952452336
Name:SMITH, I MARLENE (LAC)
Entity Type:Individual
Prefix:MS
First Name:I
Middle Name:MARLENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SUNNYBRAE CTR
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6742
Mailing Address - Country:US
Mailing Address - Phone:707-825-8558
Mailing Address - Fax:707-825-8237
Practice Address - Street 1:34 SUNNYBRAE CTR
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6742
Practice Address - Country:US
Practice Address - Phone:707-825-8558
Practice Address - Fax:707-825-8237
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist