Provider Demographics
NPI:1174843346
Name:SMITH, JOSEPH W (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1548
Mailing Address - Country:US
Mailing Address - Phone:513-231-2257
Mailing Address - Fax:
Practice Address - Street 1:3454 GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1548
Practice Address - Country:US
Practice Address - Phone:513-231-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139282164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse