Provider Demographics
NPI:1386426476
Name:SMITH, PRISCILLA DENISE
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:DENISE
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 1:116 GLENRARY RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1168
Mailing Address - Country:US
Mailing Address - Phone:919-908-3050
Mailing Address - Fax:
Practice Address - Street 1:116 GLENRARY RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1168
Practice Address - Country:US
Practice Address - Phone:919-908-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide