Provider Demographics
NPI:1649575572
Name:SMITH, BRANDY NICHOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NICHOLE
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 1:3909 WOODLEY RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1169
Mailing Address - Country:US
Mailing Address - Phone:419-764-3589
Mailing Address - Fax:
Practice Address - Street 1:3909 WOODLEY RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1169
Practice Address - Country:US
Practice Address - Phone:419-764-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142995164W00000X
OHPN.142995-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse