Provider Demographics
NPI:1518707892
Name:SMITH, SHANNA
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12436 FM 1960 RD W STE 555
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4809
Mailing Address - Country:US
Mailing Address - Phone:877-793-6020
Mailing Address - Fax:
Practice Address - Street 1:538 MAY ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-7445
Practice Address - Country:US
Practice Address - Phone:877-909-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide