Provider Demographics
NPI:1831719194
Name:SMITH, LATANYA NICOLE
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:NICOLE
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 1:5905 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3525
Mailing Address - Country:US
Mailing Address - Phone:215-852-1988
Mailing Address - Fax:215-695-2100
Practice Address - Street 1:5905 NASSAU RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3525
Practice Address - Country:US
Practice Address - Phone:215-852-1988
Practice Address - Fax:215-695-2100
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care