Healthcare Provider Details

I. General information

NPI: 1588489736
Provider Name (Legal Business Name): REBECCA LEIGH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 12/04/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 587
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST STE 587
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-6470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2371526
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2371526
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: