Healthcare Provider Details

I. General information

NPI: 1043789191
Provider Name (Legal Business Name): JADA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 F ST NW STE 3000
WASHINGTON DC
20001-1530
US

IV. Provider business mailing address

44 GALVESTON ST SW APT 101
WASHINGTON DC
20032-1917
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-8300
  • Fax:
Mailing address:
  • Phone: 202-725-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHHA13840
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: