Provider Demographics
NPI:1700341294
Name:SMITH, ANN MARIE
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SMITH
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 1:2320 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-9462
Mailing Address - Country:US
Mailing Address - Phone:937-895-4092
Mailing Address - Fax:937-855-6044
Practice Address - Street 1:2320 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-9462
Practice Address - Country:US
Practice Address - Phone:937-895-4092
Practice Address - Fax:937-855-6044
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH023713363LF0000X
OHAPRNCNP.023713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty