Provider Demographics
NPI:1881994218
Name:SMITH, DAVID LEE JR (RN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1589 E 33RD ST
Mailing Address - Street 2:FRONT APT
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-4321
Mailing Address - Country:US
Mailing Address - Phone:216-370-7991
Mailing Address - Fax:216-370-7991
Practice Address - Street 1:1589 E 33RD ST
Practice Address - Street 2:FRONT APT
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4321
Practice Address - Country:US
Practice Address - Phone:216-370-7991
Practice Address - Fax:216-370-7991
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH364897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse