Provider Demographics
NPI:1538985049
Name:SMITH, ANTHONY GERMAINE (CHW II/ PRSS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:GERMAINE
Last Name:SMITH
Suffix:
Gender:M
Credentials:CHW II/ PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 MOUNTAIN VISTA ST UNIT 20543
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89112-8104
Mailing Address - Country:US
Mailing Address - Phone:702-929-5711
Mailing Address - Fax:
Practice Address - Street 1:4948 MOUNTAIN VISTA ST UNIT 20543
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89112-8104
Practice Address - Country:US
Practice Address - Phone:702-929-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW2-5096172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker