Provider Demographics
NPI:1790923829
Name:SMITH, MOKKI ORANE (RN)
Entity Type:Individual
Prefix:MS
First Name:MOKKI
Middle Name:ORANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 YATES TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1663
Mailing Address - Country:US
Mailing Address - Phone:704-495-4049
Mailing Address - Fax:
Practice Address - Street 1:8812 YATES TERRACE
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443
Practice Address - Country:US
Practice Address - Phone:704-495-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101Y00000X
MI4704232935163WH0200X
NC178641163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163WH0200XNursing Service ProvidersRegistered NurseHome Health