Provider Demographics
NPI:1427427566
Name:SMITH, LAJUANA
Entity type:Individual
Prefix:MRS
First Name:LAJUANA
Middle Name:
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 1:6255 VILLAGE PARK DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2172
Mailing Address - Country:US
Mailing Address - Phone:313-525-2309
Mailing Address - Fax:
Practice Address - Street 1:28690 SOUTHFIELD RD
Practice Address - Street 2:STE 194B
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2728
Practice Address - Country:US
Practice Address - Phone:248-281-6147
Practice Address - Fax:248-234-8193
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker