Provider Demographics
NPI:1174030282
Name:SMITH, ANGEL YVETTE (LPN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:YVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ANGEL
Other - Middle Name:YVETTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1157 MORNINGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-4513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1157 MORNINGVIEW AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-4513
Practice Address - Country:US
Practice Address - Phone:216-924-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
774145228303OtherINDIVIDUAL PRACTIONER