MEDICARE: TERRY RICHONNE SMITH R.N. BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN255478	MA
2	163WC1500X	Community Health Registered Nurse	RN255478	MA
3	163WS0200X	School Registered Nurse	RN255478	MA

General Provider Information

NPI Number	:	1578953816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY RICHONNE SMITH R.N. BSN

Provider Business Mailing Address
First Line	:	3 WALKER RD
Second Line	:	APT 8
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-1944
Country	:	US
Telephone Number	:	978-726-0126
Fax Number	:	978-221-5814

Provider Business Practice Location Address
First Line	:	3 WALKER RD
Second Line	:	APT 8
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-1944
Country	:	US
Telephone Number	:	978-726-0126
Fax Number	:	978-221-5814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	11/13/2015

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