Provider Demographics
NPI:1235029679
Name:SMITH, RENETTA LYNNETTE
Entity type:Individual
Prefix:MISS
First Name:RENETTA
Middle Name:LYNNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15103 KREMS AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3621
Mailing Address - Country:US
Mailing Address - Phone:216-825-0061
Mailing Address - Fax:
Practice Address - Street 1:15103 KREMS AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3621
Practice Address - Country:US
Practice Address - Phone:216-825-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide