Provider Demographics
NPI:1336948512
Name:SMITH, ALICE M
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 IVY CT
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2025
Mailing Address - Country:US
Mailing Address - Phone:937-715-2509
Mailing Address - Fax:
Practice Address - Street 1:102 IVY CT
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-2025
Practice Address - Country:US
Practice Address - Phone:937-715-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide