Healthcare Provider Details

I. General information

NPI: 1417660275
Provider Name (Legal Business Name): CRYSTAL N SMITH ADN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 W SYLVANIA AVE STE 14
TOLEDO OH
43613-4397
US

IV. Provider business mailing address

2509 W SYLVANIA AVE STE 14
TOLEDO OH
43613-4397
US

V. Phone/Fax

Practice location:
  • Phone: 419-737-8164
  • Fax: 419-737-8165
Mailing address:
  • Phone: 419-737-8164
  • Fax: 419-737-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN493774
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN493774
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.493774
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN493774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: