MEDICARE: MICHELLE SMITH LPN

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	101YM0800X	Mental Health Counselor
2	164W00000X	Licensed Practical Nurse	LPN.153924.MEDS-IV	OH

General Provider Information

NPI Number	:	1851539910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SMITH LPN

Provider Business Mailing Address
First Line	:	1428 BROOKPARK DR
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3502
Country	:	US
Telephone Number	:	865-307-4603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 BROOKPARK DR
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3502
Country	:	US
Telephone Number	:	865-307-4603
Fax Number	:

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

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	08/16/2016

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Directions to “ MICHELLE SMITH LPN” Practice Location

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