Provider Demographics
NPI:1942678438
Name:SMITH, CHERRY SHAUVWN (LPN)
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:SHAUVWN
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 1:1328 ROSLYN AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2251
Mailing Address - Country:US
Mailing Address - Phone:330-949-8714
Mailing Address - Fax:
Practice Address - Street 1:1328 ROSLYN AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2251
Practice Address - Country:US
Practice Address - Phone:330-949-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-133314-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse