Provider Demographics
NPI:1093215907
Name:RICHARDSON-SMITH, WANDA ORAY
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ORAY
Last Name:RICHARDSON-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 1:4550 W SAHARA AVE APT 1192
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3611
Mailing Address - Country:US
Mailing Address - Phone:909-771-5804
Mailing Address - Fax:
Practice Address - Street 1:2001 S JONES BLVD STE F
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3165
Practice Address - Country:US
Practice Address - Phone:702-202-3452
Practice Address - Fax:702-982-8727
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747A0650X, 376J00000X, 372500000X, 372600000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion