Healthcare Provider Details

I. General information

NPI: 1184999179
Provider Name (Legal Business Name): MICHELLE RENEE SMITH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 HILLS AND DALES RD NW
CANTON OH
44708-1658
US

IV. Provider business mailing address

PO BOX 87
MIDDLEBRANCH OH
44652-0087
US

V. Phone/Fax

Practice location:
  • Phone: 330-617-5785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number376684
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN376684
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.14081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: