Healthcare Provider Details

I. General information

NPI: 1700907565
Provider Name (Legal Business Name): RHONDA FELECIA SMITH BASS CERTIFIED NURSE PRAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E 3RD ST
DAYTON OH
45403-2102
US

IV. Provider business mailing address

1101 LARONA RD
TROTWOOD OH
45426
US

V. Phone/Fax

Practice location:
  • Phone: 937-520-7889
  • Fax: 376-303-6039
Mailing address:
  • Phone: 937-854-6514
  • Fax: 937-708-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number210745
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number210745
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN.210745
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN.210745
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: