Provider Demographics
NPI:1104434836
Name:SMITH, RASHENA SHAVONNE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:RASHENA
Middle Name:SHAVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25629 LOS CABOS DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-1951
Mailing Address - Country:US
Mailing Address - Phone:310-920-0293
Mailing Address - Fax:
Practice Address - Street 1:25629 LOS CABOS DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1951
Practice Address - Country:US
Practice Address - Phone:310-920-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630561163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse