Provider Demographics
NPI:1639491160
Name:SMITH, LANETTA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LANETTA
Middle Name:MARIE
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 1:3317 ROOSEVELT BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6849
Mailing Address - Country:US
Mailing Address - Phone:513-727-4514
Mailing Address - Fax:
Practice Address - Street 1:3317 ROOSEVELT BLVD APT A
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6849
Practice Address - Country:US
Practice Address - Phone:513-727-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse