Provider Demographics
NPI:1760636179
Name:SMITH, NANCY M (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
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 1:790 CALDERWOOD CT APT B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8712
Mailing Address - Country:US
Mailing Address - Phone:513-836-0561
Mailing Address - Fax:
Practice Address - Street 1:790 CALDERWOOD CT APT B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8712
Practice Address - Country:US
Practice Address - Phone:513-836-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 098666 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse