Healthcare Provider Details

I. General information

NPI: 1598473548
Provider Name (Legal Business Name): TAKIYAH JANAE SMITH MN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

IV. Provider business mailing address

1750 EUCLID AVE APT 707
CLEVELAND OH
44115-2144
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-4010
  • Fax:
Mailing address:
  • Phone: 248-894-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number470188
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: