Provider Demographics
NPI:1013293331
Name:SMITH, JUDITH ELAINE (RN)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11797 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9129
Mailing Address - Country:US
Mailing Address - Phone:740-498-5489
Mailing Address - Fax:
Practice Address - Street 1:11797 BUCKHORN RD
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9129
Practice Address - Country:US
Practice Address - Phone:740-498-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.240612163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health