Provider Demographics
NPI:1982832911
Name:SMITH, SHIRLEY G (CNA)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 WELCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5532
Mailing Address - Country:US
Mailing Address - Phone:317-802-1777
Mailing Address - Fax:
Practice Address - Street 1:1864 WELCHWOOD CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5532
Practice Address - Country:US
Practice Address - Phone:317-802-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNAA0403623171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications