Provider Demographics
NPI:1508108606
Name:SMITH, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name: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 1:1030 HUNTERS RUN DR
Mailing Address - Street 2:APT 25
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9191
Mailing Address - Country:US
Mailing Address - Phone:513-228-0927
Mailing Address - Fax:
Practice Address - Street 1:1030 HUNTERS RUN DR
Practice Address - Street 2:APT 25
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9191
Practice Address - Country:US
Practice Address - Phone:513-228-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 120094164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse