Provider Demographics
NPI:1124307939
Name:SMART, SHIRLEY JEAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:SMART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 GOWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4657
Mailing Address - Country:US
Mailing Address - Phone:330-699-3500
Mailing Address - Fax:
Practice Address - Street 1:2823 GOWANDA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4657
Practice Address - Country:US
Practice Address - Phone:330-699-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.069323-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse