Provider Demographics
NPI:1154532190
Name:SMITH, MARILYN K (ACP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7388 W WALKER LN
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-9571
Mailing Address - Country:US
Mailing Address - Phone:812-876-1491
Mailing Address - Fax:
Practice Address - Street 1:7388 W WALKER LN
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-9571
Practice Address - Country:US
Practice Address - Phone:812-876-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health