MEDICARE: LATOYA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	374U00000X	Home Health Aide
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1073226445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA SMITH

Provider Business Mailing Address
First Line	:	8032 22ND AVE # 3087
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-6208
Country	:	US
Telephone Number	:	262-228-8837
Fax Number	:

Provider Business Practice Location Address
First Line	:	5260 N 84TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3502
Country	:	US
Telephone Number	:	262-228-8837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	01/02/2023

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Directions to “ LATOYA SMITH ” Practice Location

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