Provider Demographics
NPI:1902121239
Name:SMITH, SHARLA RACHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:SHARLA
Middle Name:RACHELLE
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 1:2601 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4216
Mailing Address - Country:US
Mailing Address - Phone:928-753-6197
Mailing Address - Fax:928-753-7756
Practice Address - Street 1:2601 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4216
Practice Address - Country:US
Practice Address - Phone:928-753-6197
Practice Address - Fax:928-753-7756
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN123171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse