Provider Demographics
NPI:1588130728
Name:SMITH, YVETTE M (STNA)
Entity type:Individual
Prefix:MISS
First Name:YVETTE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MRS
Other - First Name:YVETTE
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:3425 GLENWOOD AVE # UP
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3221
Mailing Address - Country:US
Mailing Address - Phone:585-775-6424
Mailing Address - Fax:
Practice Address - Street 1:3425 GLENWOOD AVE # UP
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3221
Practice Address - Country:US
Practice Address - Phone:585-775-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH323289430817376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH323289430817Medicaid