Provider Demographics
NPI:1346296134
Name:SMITH, SANDRA L (CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # J2-2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-538-2701
Mailing Address - Fax:216-636-6982
Practice Address - Street 1:9500 EUCLID AVE # J2-2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3494
Practice Address - Country:US
Practice Address - Phone:216-538-2701
Practice Address - Fax:216-636-6982
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN185542363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2199286Medicaid
OH2199286Medicaid
OHP16503Medicare UPIN