Provider Demographics
NPI:1477769230
Name:SMITH, VERONICA ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:ANN
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 1:2010 THOMPSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45657-8871
Mailing Address - Country:US
Mailing Address - Phone:740-372-2302
Mailing Address - Fax:
Practice Address - Street 1:2010 THOMPSON HILL RD
Practice Address - Street 2:
Practice Address - City:OTWAY
Practice Address - State:OH
Practice Address - Zip Code:45657-8871
Practice Address - Country:US
Practice Address - Phone:740-372-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.111512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2636866OtherINDEPENDENT PROVIDER