MEDICARE: MR. DAVID LEE SMITH JR. R.N.

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	163W00000X	Registered Nurse	364897	OH

General Provider Information

NPI Number	:	1881994218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID LEE SMITH JR. R.N.

Provider Business Mailing Address
First Line	:	1589 E 33RD ST
Second Line	:	FRONT APT
City	:	CLEVELAND
State	:	OH
Zip	:	44114-4321
Country	:	US
Telephone Number	:	216-370-7991
Fax Number	:	216-370-7991

Provider Business Practice Location Address
First Line	:	1589 E 33RD ST
Second Line	:	FRONT APT
City	:	CLEVELAND
State	:	OH
Zip	:	44114-4321
Country	:	US
Telephone Number	:	216-370-7991
Fax Number	:	216-370-7991

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

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	08/11/2015

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