Provider Demographics
NPI:1033197728
Name:SMITH, SUSAN M (RN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1208
Mailing Address - Country:US
Mailing Address - Phone:419-420-0904
Mailing Address - Fax:419-420-1893
Practice Address - Street 1:1917 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1208
Practice Address - Country:US
Practice Address - Phone:419-420-0904
Practice Address - Fax:419-420-1893
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM05911176B00000X
OHAPRN.CNM.05911367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2204537Medicaid