Healthcare Provider Details

I. General information

NPI: 1710410444
Provider Name (Legal Business Name): CHRISTOPHER SCOTT SMITH CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 PARK SQUARE DR STE 7
LORAIN OH
44053-4145
US

IV. Provider business mailing address

3941 COURTYARD DR
LORAIN OH
44053-4431
US

V. Phone/Fax

Practice location:
  • Phone: 440-305-6771
  • Fax: 440-305-6775
Mailing address:
  • Phone: 440-506-7547
  • Fax: 440-305-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020671
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.020671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: