Healthcare Provider Details

I. General information

NPI: 1821534298
Provider Name (Legal Business Name): DANITA SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 11/17/2021
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N HIGHWAY 67 ST SUITE 252
FLORISSANT MO
63031-5904
US

IV. Provider business mailing address

2040 WOODSON RD STE 204A
SAINT LOUIS MO
63114-5697
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-3272
  • Fax: 314-584-2205
Mailing address:
  • Phone: 314-942-3272
  • Fax: 314-584-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number152662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: