Individual
LADYBIRD MARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 4TH ST, APT 1, LEOMINSTER, MA 01453-6064
(978) 602-5191
Mailing address
128 4TH ST, APT 1, LEOMINSTER, MA 01453-6064
(978) 602-5191
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
S81307853
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004320311
—
MA
Enumeration date
10/22/2021
Last updated
10/22/2021
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