Provider Demographics
NPI:1487828604
Name:SMITH-MADYUNL, KATHERINE JEANSMITHSMITH-MADYU (LPN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEANSMITHSMITH-MADYU
Last Name:SMITH-MADYUNL
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 1:872 HOLYOKE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1839
Mailing Address - Country:US
Mailing Address - Phone:513-582-6894
Mailing Address - Fax:
Practice Address - Street 1:872 HOLYOKE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1839
Practice Address - Country:US
Practice Address - Phone:513-582-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 125811 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse