| NPI | 1902301468 |
|---|---|
| Former Name | STACEY SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0032697) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1450509) |
| 163W00000X Registered Nurse (Licence: OH 472924) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-08-05 |