Provider Demographics
NPI:1558053462
Name:SMITH, SHERREL RAVENEL
Entity Type:Individual
Prefix:
First Name:SHERREL
Middle Name:RAVENEL
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 1:1860 TURKEY PEN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3901
Mailing Address - Country:US
Mailing Address - Phone:843-225-8294
Mailing Address - Fax:
Practice Address - Street 1:1860 TURKEY PEN RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3901
Practice Address - Country:US
Practice Address - Phone:843-225-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse