Provider Demographics
NPI:1720826241
Name:SMITH, PAULETTE NO MIDDLE NAME
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:NO 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 1:143 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-1233
Mailing Address - Country:US
Mailing Address - Phone:513-600-9391
Mailing Address - Fax:
Practice Address - Street 1:143 MORRIS ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-1233
Practice Address - Country:US
Practice Address - Phone:513-600-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant