Provider Demographics
NPI:1821460700
Name:SMITH, MELISSA J (CNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 S CLEVELAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2210
Mailing Address - Country:US
Mailing Address - Phone:330-628-2686
Mailing Address - Fax:330-628-0828
Practice Address - Street 1:754 S CLEVELAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2210
Practice Address - Country:US
Practice Address - Phone:330-628-2686
Practice Address - Fax:330-628-0828
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18325-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0151368Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI