Healthcare Provider Details

I. General information

NPI: 1194044511
Provider Name (Legal Business Name): NIKITA S SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 HOPKINS AVE
LAKEWOOD OH
44107-5022
US

IV. Provider business mailing address

1537 HOPKINS AVE
LAKEWOOD OH
44107-5022
US

V. Phone/Fax

Practice location:
  • Phone: 216-258-5810
  • Fax:
Mailing address:
  • Phone: 216-258-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.339962
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: