MEDICARE: MISS GAIL ANN SMITH CNA

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	516679	CO
2	376K00000X	Nurse's Aide	516679	CO

General Provider Information

NPI Number	:	1952738213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GAIL ANN SMITH CNA

Provider Business Mailing Address
First Line	:	85 SUNFLOWER RD.
Second Line	:	#120
City	:	COLO. SPGS
State	:	CO
Zip	:	80907
Country	:	US
Telephone Number	:	719-632-5269
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 SUNFLOWER RD.
Second Line	:	#120
City	:	COLO. SPGS
State	:	CO
Zip	:	80907
Country	:	US
Telephone Number	:	719-632-5269
Fax Number	:

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

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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