Healthcare Provider Details

I. General information

NPI: 1720434046
Provider Name (Legal Business Name): ANDREA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E STATE ST OFC 233
COLUMBUS OH
43215-4281
US

IV. Provider business mailing address

21 E STATE ST OFC 233
COLUMBUS OH
43215-4281
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019808
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: