Provider Demographics
NPI:1376886309
Name:SMETZER, ALBA
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:
Last Name:SMETZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1712
Mailing Address - Country:US
Mailing Address - Phone:330-201-2143
Mailing Address - Fax:
Practice Address - Street 1:2316 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1712
Practice Address - Country:US
Practice Address - Phone:330-201-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078129Medicaid