Healthcare Provider Details

I. General information

NPI: 1437295888
Provider Name (Legal Business Name): MS. WHYSENA UMECKIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLWELLYN AVENUE
FT. MEADE MD
20755
US

IV. Provider business mailing address

719 HYDE PARK DR
GLEN BURNIE MD
21061
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8817
  • Fax: 301-677-8485
Mailing address:
  • Phone: 443-889-8633
  • Fax: 301-677-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00061501
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: