Healthcare Provider Details

I. General information

NPI: 1174952451
Provider Name (Legal Business Name): JUWANDA SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 MISTYHILL DR
CINCINNATI OH
45240-3352
US

IV. Provider business mailing address

2041 LEY AVE
CINCINNATI OH
45214-1125
US

V. Phone/Fax

Practice location:
  • Phone: 513-485-0158
  • Fax:
Mailing address:
  • Phone: 513-824-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-369038
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: