Healthcare Provider Details

I. General information

NPI: 1215311071
Provider Name (Legal Business Name): ANDREA D HUDSON SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 01/05/2021
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28100 CHAGRIN BLVD
WOODMERE OH
44122-4522
US

IV. Provider business mailing address

659 VOELKER AVE
EUCLID OH
44123-2561
US

V. Phone/Fax

Practice location:
  • Phone: 216-381-4075
  • Fax:
Mailing address:
  • Phone: 216-410-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17829-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number273982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: