MEDICARE: MRS. LISA J SMITH CNP, WHNP, MSN

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	363LW0102X	Women's Health Nurse Practitioner	14064-NP	OH

General Provider Information

NPI Number	:	1134465164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA J SMITH CNP, WHNP, MSN

Provider Business Mailing Address
First Line	:	2145 ADELBERT RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2694
Country	:	US
Telephone Number	:	216-368-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 ADELBERT RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2694
Country	:	US
Telephone Number	:	216-368-2000
Fax Number	:

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

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	08/07/2013

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