Provider Demographics
NPI:1083484257
Name:SMITH, RACHELLE MAURINE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:MAURINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 S 28TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1340
Mailing Address - Country:US
Mailing Address - Phone:405-202-9426
Mailing Address - Fax:
Practice Address - Street 1:7503 W 60TH PL N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-2369
Practice Address - Country:US
Practice Address - Phone:405-202-9426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-312391163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant