Healthcare Provider Details

I. General information

NPI: 1669930582
Provider Name (Legal Business Name): LATOYA J. SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

1964 ROSEMARY HILLS DR UNIT R1
SILVER SPRING MD
20910-6453
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1000
  • Fax:
Mailing address:
  • Phone: 917-322-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1051772
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: