Provider Demographics
NPI:1891392692
Name:SMITH, CHARLENE
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 AUSTINBURG RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9001
Mailing Address - Country:US
Mailing Address - Phone:440-998-5222
Mailing Address - Fax:
Practice Address - Street 1:7306 AUSTINBURG RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9001
Practice Address - Country:US
Practice Address - Phone:440-998-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide