MEDICARE: MS. ANGELIA DENETTE SMITH STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	376K00000X	OH

General Provider Information

NPI Number	:	1154122752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELIA DENETTE SMITH STNA

Provider Business Mailing Address
First Line	:	15953 FRIEND AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2837
Country	:	US
Telephone Number	:	216-921-2247
Fax Number	:

Provider Business Practice Location Address
First Line	:	15953 FRIEND AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2837
Country	:	US
Telephone Number	:	216-921-2247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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