Healthcare Provider Details

I. General information

NPI: 1750647640
Provider Name (Legal Business Name): TERESA L SMITH RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4196 FER DON RD
DAYTON OH
45405-1327
US

IV. Provider business mailing address

4196 FER DON RD
DAYTON OH
45405-1327
US

V. Phone/Fax

Practice location:
  • Phone: 937-620-4692
  • Fax:
Mailing address:
  • Phone: 937-620-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.216722
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN.216722
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.216722
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN.216722
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.216722
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN.216722
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN.216722
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: