Healthcare Provider Details

I. General information

NPI: 1861128068
Provider Name (Legal Business Name): MRS. SHEILHA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 CLEVELAND RD W
HURON OH
44839-1249
US

IV. Provider business mailing address

1920 CLEVELAND RD W
HURON OH
44839-1249
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0031947
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: