Provider Demographics
NPI:1659396612
Name:SMITH, AMY L (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-291-4000
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:1220 E ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2803
Practice Address - Country:US
Practice Address - Phone:419-228-8245
Practice Address - Fax:419-998-8247
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.03884367A00000X
FLARNP9258147367A00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017698300Medicaid
OH2050873Medicaid
FL7WFC3OtherFLORIDA BLUE
FL1296454OtherSTAYWELL MEDICAID
MI1659396612Medicaid
FL7WFC3OtherFLORIDA BLUE
MI1659396612Medicaid
FL1296454OtherSTAYWELL MEDICAID
OH2050873Medicaid