Provider Demographics
NPI:1568291961
Name:SEARS SMITH, WAYNE
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:SEARS SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 PLOWMAN PL UNIT 106
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-3624
Mailing Address - Country:US
Mailing Address - Phone:614-779-4914
Mailing Address - Fax:
Practice Address - Street 1:3461 HUDDLE WAY
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-3584
Practice Address - Country:US
Practice Address - Phone:380-210-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402140310119376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide