Provider Demographics
NPI:1689777070
Name:SMITH, DAVID MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7274 US ROUTE 224
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-8912
Mailing Address - Country:US
Mailing Address - Phone:419-203-7675
Mailing Address - Fax:
Practice Address - Street 1:7274 US ROUTE 224
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-8912
Practice Address - Country:US
Practice Address - Phone:419-203-7675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA203055367500000X
WV107513367500000X
VA0024165429367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00439752Medicare PIN
VA004089P50Medicare PIN
VA0146868W82Medicare PIN