Healthcare Provider Details

I. General information

NPI: 1295943462
Provider Name (Legal Business Name): REBECCA ANN SMITH APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 1800
STRATFORD NJ
08084-1338
US

IV. Provider business mailing address

461 WEYMOUTH RD
BUENA NJ
08310-1625
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6843
  • Fax: 856-566-6419
Mailing address:
  • Phone: 609-226-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number26NJ00126900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00126900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: