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General NPI Number Information
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NPI Number | 1942122114
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Entity Type | Individual
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Provider Name | BROOKE SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 24 HYDE ST
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City | WAKEMAN
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State | OH
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Zip | 44889-9301
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Country | US
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Telephone | 440-839-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 6211 KRYSTINA RUN
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City | LORAIN
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State | OH
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Zip | 44053-1837
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.010468RX
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License Number State | OH
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