Healthcare Provider Details

I. General information

NPI: 1265920391
Provider Name (Legal Business Name): JANET E SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6843 E 52ND ST
INDIANAPOLIS IN
46226-2645
US

IV. Provider business mailing address

5200 N SHADELAND AVE
INDIANAPOLIS IN
46226-1810
US

V. Phone/Fax

Practice location:
  • Phone: 317-438-5585
  • Fax:
Mailing address:
  • Phone: 317-438-5585
  • Fax: 866-361-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: