Provider Demographics
NPI:1205277829
Name:SMITH, RUSTIE LYNN
Entity type:Individual
Prefix:MISS
First Name:RUSTIE
Middle Name:LYNN
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 1:1401 PLAIN CITY GEORGESVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9601
Mailing Address - Country:US
Mailing Address - Phone:614-582-6965
Mailing Address - Fax:614-879-9161
Practice Address - Street 1:1401 PLAIN CITY GEORGESVILLE RD SE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9601
Practice Address - Country:US
Practice Address - Phone:614-582-6965
Practice Address - Fax:614-879-9161
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant