MEDICARE: DANETTE 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	390200000X	Student in an Organized Health Care Education/Training Program		VA

General Provider Information

NPI Number	:	1447846993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANETTE SMITH

Provider Business Mailing Address
First Line	:	1619 G ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3132
Country	:	US
Telephone Number	:	202-421-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 G ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3132
Country	:	US
Telephone Number	:	202-421-4522
Fax Number	:

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

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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Directions to “ DANETTE SMITH ” Practice Location

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