Provider Demographics
NPI:1750647640
Name:SMITH, TERESA L (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
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 1:4196 FER DON RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1327
Mailing Address - Country:US
Mailing Address - Phone:937-620-4692
Mailing Address - Fax:
Practice Address - Street 1:4196 FER DON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1327
Practice Address - Country:US
Practice Address - Phone:937-620-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.216722163W00000X, 163WC1600X, 163WH0200X, 163WI0500X, 163WP0809X, 163WP1700X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WW0000XNursing Service ProvidersRegistered NurseWound Care