Provider Demographics
NPI:1780218974
Name:SMITH, CLARICE LENEE (LPN)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:LENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3866 EMMA PKWY
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1200
Mailing Address - Country:US
Mailing Address - Phone:567-712-3456
Mailing Address - Fax:
Practice Address - Street 1:3866 EMMA PKWY
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1200
Practice Address - Country:US
Practice Address - Phone:567-712-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse