Provider Demographics
NPI: | 1356191225 |
---|---|
Name: | SMITH, MADELINE ROSE (DNP, CCRN, BSN, RN) |
Entity type: | Individual |
Prefix: | |
First Name: | MADELINE |
Middle Name: | ROSE |
Last Name: | SMITH |
Suffix: | |
Gender: | F |
Credentials: | DNP, CCRN, BSN, RN |
Other - Prefix: | |
Other - First Name: | MADELINE |
Other - Middle Name: | ROSE |
Other - Last Name: | O'FLAHERTY |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 3301 MERCY HEALTH BLVD STE 125 |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45211-1106 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-215-9200 |
Mailing Address - Fax: | 513-215-9259 |
Practice Address - Street 1: | 3301 MERCY HEALTH BLVD STE 125 |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45211-1106 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-215-9200 |
Practice Address - Fax: | 513-215-9259 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2024-03-25 |
Last Update Date: | 2024-10-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | APRN.CNP.0035985 | 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |