Provider Demographics
NPI:1225354830
Name:SMITH, ANN MARIE (PHD, RN, CRRN, ANP)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, RN, CRRN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 W 10TH AVE
Mailing Address - Street 2:2256 CRAMBLETT CLINIC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-3021
Mailing Address - Fax:
Practice Address - Street 1:456 W 10TH AVE
Practice Address - Street 2:2256 CRAMBLETT CLINIC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 212109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse