Provider Demographics
NPI:1497044473
Name:SMITH, RITA ANN (LVN)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12156 SPROUL ST APT 15
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3161
Mailing Address - Country:US
Mailing Address - Phone:562-407-4283
Mailing Address - Fax:
Practice Address - Street 1:12156 SPROUL ST APT 15
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3161
Practice Address - Country:US
Practice Address - Phone:562-407-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 155422164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse