Provider Demographics
NPI:1578953816
Name:SMITH, TERRY RICHONNE (RN BSN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:RICHONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WALKER RD
Mailing Address - Street 2:APT 8
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1944
Mailing Address - Country:US
Mailing Address - Phone:978-726-0126
Mailing Address - Fax:978-221-5814
Practice Address - Street 1:3 WALKER RD
Practice Address - Street 2:APT 8
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1944
Practice Address - Country:US
Practice Address - Phone:978-726-0126
Practice Address - Fax:978-221-5814
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255478163W00000X, 163WC1500X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool