Provider Demographics
NPI:1902248743
Name:SMITH, GESHELLE NICHOLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:GESHELLE
Middle Name:NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PALMER CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5072
Mailing Address - Country:US
Mailing Address - Phone:513-403-7794
Mailing Address - Fax:513-742-5036
Practice Address - Street 1:19 PALMER CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5072
Practice Address - Country:US
Practice Address - Phone:513-403-7794
Practice Address - Fax:513-742-5036
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN144143164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse