Provider Demographics
NPI:1356762462
Name:SMITH, CHEVONNE (MSN, APRN-CNP, CCRN)
Entity type:Individual
Prefix:
First Name:CHEVONNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN-CNP, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 W MARKET ST STE 240
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3624
Mailing Address - Country:US
Mailing Address - Phone:234-201-7811
Mailing Address - Fax:
Practice Address - Street 1:3094 W MARKET ST STE 240
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3624
Practice Address - Country:US
Practice Address - Phone:234-201-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN350294163WN0002X
OHAPRN.CNP.025388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care