Provider Demographics
NPI:1134465164
Name:SMITH, LISA J (CNP, WHNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP, WHNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 ADELBERT RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2694
Mailing Address - Country:US
Mailing Address - Phone:216-368-2000
Mailing Address - Fax:
Practice Address - Street 1:2145 ADELBERT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2694
Practice Address - Country:US
Practice Address - Phone:216-368-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14064-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health