Individual
SHELLY ROBERTA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
10125 PINESHADOW DR APT 207, CHARLOTTE, NC 28262-1164
(864) 985-8034
Mailing address
10125 PINESHADOW DR APT 207, CHARLOTTE, NC 28262-1164
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
245193
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245193
REGISTERED NURSE
NC
Enumeration date
09/21/2022
Last updated
09/21/2022
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