Provider Demographics
NPI:1669015574
Name:SMITH, JEANNETTA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JEANNETTA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2403
Mailing Address - Country:US
Mailing Address - Phone:216-269-4397
Mailing Address - Fax:
Practice Address - Street 1:217 GREENBRIAR CT
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44143-2403
Practice Address - Country:US
Practice Address - Phone:216-269-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.310949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse