Provider Demographics
NPI:1437317922
Name:SMITH, LENETTE
Entity Type:Individual
Prefix:
First Name:LENETTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11118 WILLOWMERE AVE # DN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2757
Mailing Address - Country:US
Mailing Address - Phone:216-240-8494
Mailing Address - Fax:216-375-3429
Practice Address - Street 1:11118 WILLOWMERE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2757
Practice Address - Country:US
Practice Address - Phone:216-240-8494
Practice Address - Fax:216-375-3429
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459898Medicaid