Provider Demographics
NPI:1598473548
Name:SMITH, TAKIYAH JANAE (MN, RN)
Entity Type:Individual
Prefix:MS
First Name:TAKIYAH
Middle Name:JANAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 EUCLID AVE APT 707
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2144
Mailing Address - Country:US
Mailing Address - Phone:248-894-8533
Mailing Address - Fax:
Practice Address - Street 1:12201 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4310
Practice Address - Country:US
Practice Address - Phone:216-721-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH470188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNOT ASSOCIATED