MEDICARE: LAZELL SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174185979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAZELL SMITH

Provider Business Mailing Address
First Line	:	6490 S MCCARRAN BLVD STE C21
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-6123
Country	:	US
Telephone Number	:	916-761-3763
Fax Number	:

Provider Business Practice Location Address
First Line	:	6490 S MCCARRAN BLVD STE C21
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-6123
Country	:	US
Telephone Number	:	775-825-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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Directions to “ LAZELL SMITH ” Practice Location

Language	Start Address	Practice Location

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