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General NPI Number Information
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NPI Number | 1780183434
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Entity Type | Individual
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Provider Name | TIANNA L SMITH
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Gender | Female
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 439 FASSEN ST
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1912
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Country | US
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Telephone | 314-484-1846
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Fax |
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Provider Business Mailing Address
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Address Line | 8204 GRAVOIS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63123-4725
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Country | US
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Telephone | 314-405-1114
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | X137003006
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License Number State | MO
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