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General NPI Number Information
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NPI Number | 1871855569
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Entity Type | Individual
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Provider Name | ANDRETTA JENE' SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/09/2012
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Last Update Date | 06/09/2012
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Provider Practice Location Address
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Address Line | 11115 MILLS RD STE 114
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City | CYPRESS
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State | TX
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Zip | 77429-3036
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Country | US
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Telephone | 832-465-2512
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Fax | 281-890-1884
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Provider Business Mailing Address
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Address Line | 11115 MILLS RD STE 114
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City | CYPRESS
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State | TX
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Zip | 77429-3036
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Country | US
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Telephone | 832-465-2512
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Fax | 281-890-1884
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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 |
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License Number State |
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