Provider Demographics
NPI:1386947950
Name:BEADEL SMITH, DAYNA ROSALIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:ROSALIE
Last Name:BEADEL SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DAYNA
Other - Middle Name:ROSALIE
Other - Last Name:BURDICK-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:799 N DEERLANE LOOP
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:OR
Mailing Address - Zip Code:97368-9677
Mailing Address - Country:US
Mailing Address - Phone:541-994-7689
Mailing Address - Fax:
Practice Address - Street 1:799 N DEERLANE LOOP
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368-9677
Practice Address - Country:US
Practice Address - Phone:541-994-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030327LPN164X00000X
TX127745164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse