Provider Demographics
NPI:1891737862
Name:SMITH, LORI D (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:D
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 1:336 PARK DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-9615
Mailing Address - Country:US
Mailing Address - Phone:513-839-1002
Mailing Address - Fax:513-988-1525
Practice Address - Street 1:336 PARK DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-9615
Practice Address - Country:US
Practice Address - Phone:513-839-1002
Practice Address - Fax:513-988-1525
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.109870164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2369388Medicaid