MEDICARE: MS. YVONNE SMITH LPN

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	164W00000X	Licensed Practical Nurse	PN110184	OH

General Provider Information

NPI Number	:	1902980998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YVONNE SMITH LPN

Provider Business Mailing Address
First Line	:	2972 SPLITROCK RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-1960
Country	:	US
Telephone Number	:	614-529-4999
Fax Number	:	614-529-4999

Provider Business Practice Location Address
First Line	:	9515 HIGH FREE PIKE
Second Line	:
City	:	WEST JEFFERSON
State	:	OH
Zip	:	43162-9615
Country	:	US
Telephone Number	:	614-879-7746
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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