MEDICARE: MS. SHIRLEY G SMITH CNA

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	171WH0202X	Home Modifications Contractor	CNAA0403623	IN

General Provider Information

NPI Number	:	1982832911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY G SMITH CNA

Provider Business Mailing Address
First Line	:	1864 WELCHWOOD CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5532
Country	:	US
Telephone Number	:	317-802-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1864 WELCHWOOD CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5532
Country	:	US
Telephone Number	:	317-802-1777
Fax Number	:

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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