Individual
JAMIKA RENE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
173 W GODFREY AVE, PHILADELPHIA, PA 19120-1519
(267) 453-1732
Mailing address
173 W GODFREY AVE, PHILADELPHIA, PA 19120-1519
(267) 453-1732
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN290179
PA
Other
Enumeration date
05/18/2018
Last updated
05/18/2018
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