Provider Demographics
NPI:1831592575
Name:SMITH, BILLIE (STNA)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:16892 DALE ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9423
Mailing Address - Country:US
Mailing Address - Phone:330-708-8012
Mailing Address - Fax:
Practice Address - Street 1:16892 DALE ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9423
Practice Address - Country:US
Practice Address - Phone:330-708-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400768800608376K00000X
PA10013551376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide