Provider Demographics
NPI:1780239863
Name:SMITH, TERRY LYNN (CAREGIVER)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S VALLEY VIEW BLVD APT 1136
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1696
Mailing Address - Country:US
Mailing Address - Phone:574-323-8556
Mailing Address - Fax:
Practice Address - Street 1:5000 ALTA DR APT 426
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3935
Practice Address - Country:US
Practice Address - Phone:702-980-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide