Provider Demographics
NPI:1881878718
Name:SMITH, YOLANDA RAYMONIA
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:RAYMONIA
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 1:18851 NAUMANN AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1661
Mailing Address - Country:US
Mailing Address - Phone:216-486-7807
Mailing Address - Fax:
Practice Address - Street 1:18851 NAUMANN AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1661
Practice Address - Country:US
Practice Address - Phone:216-486-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300021163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2344494OtherMEDICAID PROVIDER