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General NPI Number Information
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NPI Number | 1467193995
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Entity Type | Individual
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Provider Name | GWONDA SMITH
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 732 EDEN WAY N SUITE H
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-716-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 732 EDEN WAY N SUITE H 1202 WELLES CT
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-716-1273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 103514
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License Number State | VA
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