Provider Demographics
NPI:1508469859
Name:SMITH, REBECCA YVONNE (STNA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:YVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:YVONNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STNA
Mailing Address - Street 1:323 N MATHISON ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-2444
Mailing Address - Country:US
Mailing Address - Phone:937-212-3299
Mailing Address - Fax:
Practice Address - Street 1:323 N MATHISON ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-2444
Practice Address - Country:US
Practice Address - Phone:937-212-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400827581108376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide