Provider Demographics
NPI:1235102294
Name:SMITHERS, LISA MARIE (CNM, MSN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:REINHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, MSN
Mailing Address - Street 1:150 MOREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1646
Mailing Address - Country:US
Mailing Address - Phone:937-644-1244
Mailing Address - Fax:937-642-7535
Practice Address - Street 1:150 MOREY DRIVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1646
Practice Address - Country:US
Practice Address - Phone:937-644-1244
Practice Address - Fax:937-642-7535
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN294608/NM08132367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577288Medicaid