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Individual

MS. MARY ANNE SMITH

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
HHA

Contact information

Practice address
452 MADISON ST, CONNEAUT, OH 44030-2504
(440) 593-4656
Mailing address
452 MADISON ST, CONNEAUT, OH 44030-2504
(440) 593-4656

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2290560
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2290560
OH
Enumeration date
06/14/2006
Last updated
07/09/2007
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