Provider Demographics
NPI:1770679565
Name:RAKESMITH, CHRISTINE DAWN (MSN RN CNP BC-G)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DAWN
Last Name:RAKESMITH
Suffix:
Gender:F
Credentials:MSN RN CNP BC-G
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:DAWN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1715 INDIAN WOOD CIR
Practice Address - Street 2:SUITE 200 OFFICE 265 AND 266
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4055
Practice Address - Country:US
Practice Address - Phone:419-578-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07389363LG0600X
OHCOA.07389-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415621Medicaid
OH2415621Medicaid
OHP93568Medicare UPIN
MR2011055OtherDEA