Provider Demographics
NPI:1386269066
Name:SMITH, ALLYSHA TAWANA (RN)
Entity type:Individual
Prefix:MISS
First Name:ALLYSHA
Middle Name:TAWANA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3835
Mailing Address - Country:US
Mailing Address - Phone:484-469-3787
Mailing Address - Fax:
Practice Address - Street 1:204 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3835
Practice Address - Country:US
Practice Address - Phone:484-469-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN706154163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse