Provider Demographics
NPI:1427132687
Name:SMITH, STEPHANIE DENISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DENISE
Last Name:SMITH
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 1:7695 BARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4899
Mailing Address - Country:US
Mailing Address - Phone:614-404-1304
Mailing Address - Fax:
Practice Address - Street 1:7695 BARKWOOD DR
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4899
Practice Address - Country:US
Practice Address - Phone:614-404-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2550181Medicaid