Provider Demographics
NPI:1205300563
Name:SMITH, JERRI
Entity type:Individual
Prefix:MISS
First Name:JERRI
Middle Name:
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 1:10317 BALSAMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3178
Mailing Address - Country:US
Mailing Address - Phone:202-322-9779
Mailing Address - Fax:
Practice Address - Street 1:3232 GEORGIA AVE NW APT 617
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3089
Practice Address - Country:US
Practice Address - Phone:202-315-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant