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General NPI Number Information
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NPI Number | 1518707892
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Entity Type | Individual
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Provider Name | SHANNA SMITH
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Gender |
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Dates
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Enumeration Date | 05/25/2024
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Last Update Date | 05/25/2024
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Provider Practice Location Address
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Address Line | 538 MAY ST
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City | WAUKEGAN
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State | IL
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Zip | 60085-7445
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Country | US
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Telephone | 877-909-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 12436 FM 1960 RD W STE 555
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City | HOUSTON
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State | TX
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Zip | 77065-4809
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Country | US
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Telephone | 877-793-6020
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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