Provider Demographics
NPI:1194576165
Name:SMITH, RACHAEL (BS, CHW)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N HAGADORN RD # 2W
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2320
Mailing Address - Country:US
Mailing Address - Phone:517-364-8187
Mailing Address - Fax:
Practice Address - Street 1:2446 JOLLY RD STE B
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3514
Practice Address - Country:US
Practice Address - Phone:517-253-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker