Provider Demographics
NPI:1548580277
Name:SMITH, LISA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8684 SUNSET VALLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9619
Mailing Address - Country:US
Mailing Address - Phone:330-854-0240
Mailing Address - Fax:
Practice Address - Street 1:8684 SUNSET VALLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9619
Practice Address - Country:US
Practice Address - Phone:330-854-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN247705163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse