Provider Demographics
NPI:1295943462
Name:SMITH, REBECCA ANN (APN,C)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WEYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BUENA
Mailing Address - State:NJ
Mailing Address - Zip Code:08310-1625
Mailing Address - Country:US
Mailing Address - Phone:609-226-1565
Mailing Address - Fax:
Practice Address - Street 1:42 E LAUREL RD STE 1800
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1338
Practice Address - Country:US
Practice Address - Phone:856-566-6843
Practice Address - Fax:856-566-6419
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00126900364SA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0311880Medicaid
NJ808486OtherMEDICARE ID