MEDICARE: LAVONNE MONIQUE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	RN486572	OH

General Provider Information

NPI Number	:	1124974555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVONNE MONIQUE SMITH

Provider Business Mailing Address
First Line	:	4747 BARTLAM AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1808
Country	:	US
Telephone Number	:	330-888-3747
Fax Number	:

Provider Business Practice Location Address
First Line	:	4747 BARTLAM AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1808
Country	:	US
Telephone Number	:	330-888-3747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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