Provider Demographics
NPI:1659821734
Name:SMITH, CLARA ANN (STNA)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 E 110TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-2667
Mailing Address - Country:US
Mailing Address - Phone:216-339-8308
Mailing Address - Fax:
Practice Address - Street 1:2497 E 110TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-2667
Practice Address - Country:US
Practice Address - Phone:216-339-8308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401893780816376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide