Provider Demographics
NPI:1124670641
Name:SMITH, REBECCA ELIZABETH (DNP)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 TRADITIONAL LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-5600
Mailing Address - Country:US
Mailing Address - Phone:305-394-0494
Mailing Address - Fax:
Practice Address - Street 1:1605 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7405
Practice Address - Country:US
Practice Address - Phone:910-343-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011992363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care