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NPI Code Detail

MEDICARE: ROSANETTA SMITH

MEDICARE: ROSANETTA 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
1251E00000XHome Health AgencyNV20181306317NV

General Provider Information

NPI Number : 1629559596
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSANETTA SMITH
Provider Business Mailing Address
First Line : 1104 FERGUSON AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-5391
Country : US
Telephone Number : 702-553-8139
Fax Number : 702-553-8139
Provider Business Practice Location Address
First Line : 1104 FERGUSON AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-5391
Country : US
Telephone Number : 702-553-8139
Fax Number : 702-553-8139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2018
Last Update Date : 08/28/2018

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Directions to “ ROSANETTA SMITH ” Practice Location

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