Provider Demographics
NPI:1326694522
Name:FENNELL-SMITH, RENITA
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:
Last Name:FENNELL-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 1:24 PARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1815
Mailing Address - Country:US
Mailing Address - Phone:267-241-7233
Mailing Address - Fax:
Practice Address - Street 1:24 PARKVIEW RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1815
Practice Address - Country:US
Practice Address - Phone:267-241-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN086948L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse