Provider Demographics
NPI:1528362316
Name:SMITH, NICOLE AMBER (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMBER
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 1:820 UNION BLVD
Mailing Address - Street 2:APT. 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2126
Mailing Address - Country:US
Mailing Address - Phone:740-607-6479
Mailing Address - Fax:
Practice Address - Street 1:820 UNION BLVD
Practice Address - Street 2:APT. 101
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2126
Practice Address - Country:US
Practice Address - Phone:740-607-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN142898-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse