Provider Demographics
NPI:1609109347
Name:SMITH, VICKI JO (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:VICKI
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 E LAKE RD
Mailing Address - Street 2:APT 206
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-1751
Mailing Address - Country:US
Mailing Address - Phone:440-785-8570
Mailing Address - Fax:
Practice Address - Street 1:5115 E LAKE RD
Practice Address - Street 2:APT 206
Practice Address - City:SHEFFIELD LAKE
Practice Address - State:OH
Practice Address - Zip Code:44054-1751
Practice Address - Country:US
Practice Address - Phone:440-785-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN197890163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health