Provider Demographics
NPI:1225353444
Name:SMITH, CARLINE ANDREA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARLINE
Middle Name:ANDREA
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 1:1635 CADNEY ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1192
Mailing Address - Country:US
Mailing Address - Phone:330-491-0345
Mailing Address - Fax:
Practice Address - Street 1:1635 CADNEY ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1192
Practice Address - Country:US
Practice Address - Phone:330-491-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 109552164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse