Healthcare Provider Details

I. General information

NPI: 1619386794
Provider Name (Legal Business Name): ERIN MARIE SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MARIE BUSHNELL CNP

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8521
  • Fax: 330-543-8530
Mailing address:
  • Phone: 330-308-5432
  • Fax: 330-339-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15886-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: