MEDICARE: DESIREE SMITH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1467001511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE SMITH

Provider Business Mailing Address
First Line	:	7251 W LAKE MEAD BLVD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8380
Country	:	US
Telephone Number	:	702-562-4344
Fax Number	:	702-562-4345

Provider Business Practice Location Address
First Line	:	5048 MILANGE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2309
Country	:	US
Telephone Number	:	619-647-7696
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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Directions to “ DESIREE SMITH ” Practice Location

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