Provider Demographics
NPI:1952978603
Name:SMITH, SHWAYNEA LYNETTE
Entity Type:Individual
Prefix:
First Name:SHWAYNEA
Middle Name:LYNETTE
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 1:4801 SPENCER ST APT 172
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6265
Mailing Address - Country:US
Mailing Address - Phone:702-881-0963
Mailing Address - Fax:
Practice Address - Street 1:4801 SPENCER ST APT 172
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6265
Practice Address - Country:US
Practice Address - Phone:702-881-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant