Healthcare Provider Details

I. General information

NPI: 1124333083
Provider Name (Legal Business Name): STACEY MICHELLE SMETZER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2696
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE
COLUMBUS OH
43205-2696
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2350
  • Fax: 614-722-2350
Mailing address:
  • Phone: 614-722-2350
  • Fax: 614-722-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.334240-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11641-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: