Provider Demographics
NPI:1588849376
Name:SMITH, MARY E (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1000
Mailing Address - Country:US
Mailing Address - Phone:419-841-7701
Mailing Address - Fax:419-841-1691
Practice Address - Street 1:6605 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1000
Practice Address - Country:US
Practice Address - Phone:419-841-7701
Practice Address - Fax:419-841-1691
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 157065163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse