Individual
JEANNIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
813 FORREST DR, STE D-1, NEWPORT NEWS, VA 23606-4513
(757) 287-6135
Mailing address
103 LAMPER RD, PORTSMOUTH, VA 23701-1115
(757) 287-6135
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0019004099
VA
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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