Provider Demographics
NPI:1447004916
Name:SMITH, SHANQUANET
Entity type:Individual
Prefix:
First Name:SHANQUANET
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 W LUSCHER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5240
Mailing Address - Country:US
Mailing Address - Phone:404-956-9691
Mailing Address - Fax:
Practice Address - Street 1:4229 W LUSCHER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5240
Practice Address - Country:US
Practice Address - Phone:404-956-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No342000000XTransportation ServicesTransportation Network Company