MEDICARE: RACHEL MICHELLE SMITH NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0002076558	VA

General Provider Information

NPI Number	:	1598583049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MICHELLE SMITH NURSE

Provider Business Mailing Address
First Line	:	6731 WAYMORE LN
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-3782
Country	:	US
Telephone Number	:	804-920-7821
Fax Number	:

Provider Business Practice Location Address
First Line	:	6731 WAYMORE LN
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-3782
Country	:	US
Telephone Number	:	804-920-7821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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