Individual
LYDIA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
750 W BASELINE RD APT 2034, TEMPE, AZ 85283-5927
(616) 432-4547
Mailing address
750 W BASELINE RD APT 2034, TEMPE, AZ 85283-5927
(616) 432-4547
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VS0116709
—
MI
Enumeration date
08/07/2019
Last updated
08/07/2019
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