Provider Demographics
NPI:1881047454
Name:SMITH, VANESSA RENEE (RN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19175
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-0175
Mailing Address - Country:US
Mailing Address - Phone:216-264-6909
Mailing Address - Fax:
Practice Address - Street 1:7575 TYLER BLVD STE C40
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5441
Practice Address - Country:US
Practice Address - Phone:216-264-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.403853163WD0400X, 171M00000X
OHRN 403853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator