Provider Demographics
NPI:1356138598
Name:SMITH, JAKE
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22052 US HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-9658
Mailing Address - Country:US
Mailing Address - Phone:937-728-2809
Mailing Address - Fax:
Practice Address - Street 1:22052 US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-9658
Practice Address - Country:US
Practice Address - Phone:937-728-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker