Provider Demographics
NPI:1407048101
Name:SMITH, ROBERTA COLLEEN (RN)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:COLLEEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 YORK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2130
Mailing Address - Country:US
Mailing Address - Phone:410-887-3432
Mailing Address - Fax:
Practice Address - Street 1:6401 YORK RD STE 3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2130
Practice Address - Country:US
Practice Address - Phone:410-887-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO48781163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management