Individual
SHELBY REBECCA SMART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1200 INTREPID AVE, PHILADELPHIA, PA 19112-1229
(864) 764-0322
Mailing address
6642 BITTNERS CORNER RD, NEW TRIPOLI, PA 18066-2519
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
95294467
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95294467
RN LICENSE
CA
Enumeration date
10/31/2022
Last updated
10/31/2022
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