Provider Demographics
NPI:1114292091
Name:SMITH, CHRISTINA DIANNE (STNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-9520
Mailing Address - Country:US
Mailing Address - Phone:740-360-5304
Mailing Address - Fax:
Practice Address - Street 1:1439 STEVENS RD
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9520
Practice Address - Country:US
Practice Address - Phone:740-360-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400166211002376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide