Provider Demographics
NPI:1780982116
Name:SMITH, IOLA EUNICE (RD, L/DN)
Entity type:Individual
Prefix:
First Name:IOLA
Middle Name:EUNICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, L/DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 NW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4678
Mailing Address - Country:US
Mailing Address - Phone:954-290-0037
Mailing Address - Fax:954-535-1089
Practice Address - Street 1:4229 NW 50TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4678
Practice Address - Country:US
Practice Address - Phone:954-290-0037
Practice Address - Fax:954-535-1089
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered