Provider Demographics
NPI:1336621507
Name:SMITH, SHARON ROSEMARY (MSN RN CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ROSEMARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN RN CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 SANTA ANITA DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6211
Mailing Address - Country:US
Mailing Address - Phone:330-686-3194
Mailing Address - Fax:
Practice Address - Street 1:2713 SANTA ANITA DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6211
Practice Address - Country:US
Practice Address - Phone:330-686-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019719363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics