Provider Demographics
NPI:1508197963
Name:SMOSNY, HEATHER MARIE (STNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:SMOSNY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 LAWRENCE CT APT 104
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-1726
Mailing Address - Country:US
Mailing Address - Phone:330-998-9004
Mailing Address - Fax:
Practice Address - Street 1:922 LAWRENCE CT APT 104
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1726
Practice Address - Country:US
Practice Address - Phone:330-998-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400940660709376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide