Healthcare Provider Details

I. General information

NPI: 1104145267
Provider Name (Legal Business Name): RACHEL CATHERINE SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 OCEAN PKWY APT 3B
BROOKLYN NY
11218-1763
US

IV. Provider business mailing address

117 E 39TH ST APT 4R
NEW YORK NY
10016-0904
US

V. Phone/Fax

Practice location:
  • Phone: 718-871-1365
  • Fax:
Mailing address:
  • Phone: 917-860-2971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number613845-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: