Individual
MARY ELLEN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
847 STATE ST, GASSAWAY, WV 26624-9303
(304) 364-8113
Mailing address
RR 1 BOX 108, FRAMETOWN, WV 26623-9740
(304) 364-5571
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2008-2502
WV
Other
Enumeration date
01/21/2009
Last updated
01/11/2011
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