Provider Demographics
NPI:1386047876
Name:SMITH, LOUNA M
Entity type:Individual
Prefix:
First Name:LOUNA
Middle Name:M
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 1:354 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1341
Mailing Address - Country:US
Mailing Address - Phone:508-857-5598
Mailing Address - Fax:508-857-5641
Practice Address - Street 1:354 OAK ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1341
Practice Address - Country:US
Practice Address - Phone:508-857-5598
Practice Address - Fax:508-857-5641
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide