Provider Demographics
NPI:1548419344
Name:SMITH, HEATHER ELAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELAINE
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 1:630 DORMAN RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-9666
Mailing Address - Country:US
Mailing Address - Phone:440-813-9908
Mailing Address - Fax:
Practice Address - Street 1:630 DORMAN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-9666
Practice Address - Country:US
Practice Address - Phone:440-813-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 105365 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse