Provider Demographics
NPI:1215054614
Name:SMITH, SHANA LYNNE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N MADISON RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1014
Mailing Address - Country:US
Mailing Address - Phone:740-852-5729
Mailing Address - Fax:
Practice Address - Street 1:134 N MADISON RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1014
Practice Address - Country:US
Practice Address - Phone:740-852-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2317317163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice