Provider Demographics
NPI:1639454853
Name:SMITH, AMBER MONET (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MONET
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 1:15 BLOOMFIELD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607
Mailing Address - Country:US
Mailing Address - Phone:419-283-2235
Mailing Address - Fax:
Practice Address - Street 1:15 BLOOMFIELD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607
Practice Address - Country:US
Practice Address - Phone:419-283-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN13874M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse