Basic Information
Provider Information
NPI: 1982638540
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SMITH
FirstName: MICHELLE
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: APRN-CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SCHRAND
OtherFirstName: MICHELLE
OtherMiddleName: LYNN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3333 BURNET AVE
Address2: ML 5021
City: CINCINNATI
State: OH
PostalCode: 452293039
CountryCode: US
TelephoneNumber: 5136364225
FaxNumber: 5136362511
Practice Location
Address1: 3333 BURNET AVE
Address2: ML 2008
City: CINCINNATI
State: OH
PostalCode: 452293039
CountryCode: US
TelephoneNumber: 5136367966
FaxNumber: 5136367967
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 05/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XRN.238006-COA1OHN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
363L00000XAPRN.CNP.03920OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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