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General NPI Number Information
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NPI Number | 1861824633
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Entity Type | Individual
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Provider Name | KAZAMA O'VELLA SMITH
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Gender | Female
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 19701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 19701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-791-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN-095533
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN08264
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License Number State | GA
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