Healthcare Provider Details

I. General information

NPI: 1922737733
Provider Name (Legal Business Name): NICOLE MARIE SMITH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3893 E MARKET ST
WARREN OH
44484-4706
US

IV. Provider business mailing address

3893 E MARKET ST
WARREN OH
44484-4706
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-7551
  • Fax: 330-856-4251
Mailing address:
  • Phone: 330-856-7551
  • Fax: 330-856-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number02392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: