Provider Demographics
NPI:1568159135
Name:SMITH, RAENIESHA RENAE
Entity Type:Individual
Prefix:
First Name:RAENIESHA
Middle Name:RENAE
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 1:310 ANACOSTIA RD SE APT A22
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7115
Mailing Address - Country:US
Mailing Address - Phone:202-446-7567
Mailing Address - Fax:
Practice Address - Street 1:1758 STANTON TER SE # A22
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2824
Practice Address - Country:US
Practice Address - Phone:202-368-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant