Provider Demographics
NPI:1164645677
Name:SMITH, SONNIE LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SONNIE
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8197 FARM CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7108
Mailing Address - Country:US
Mailing Address - Phone:740-816-1211
Mailing Address - Fax:
Practice Address - Street 1:6006 MANOR HOUSE WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1536
Practice Address - Country:US
Practice Address - Phone:614-403-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN079945164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse