Healthcare Provider Details

I. General information

NPI: 1114041373
Provider Name (Legal Business Name): MS. VALERIE A SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 S 3RD ST
COLUMBUS OH
43207-1005
US

IV. Provider business mailing address

1378 S 3RD ST
COLUMBUS OH
43207-1005
US

V. Phone/Fax

Practice location:
  • Phone: 614-406-3419
  • Fax: 614-445-0950
Mailing address:
  • Phone: 614-406-3419
  • Fax: 614-445-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number2219601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: