Provider Demographics
NPI:1487360228
Name:SMITH, RAYANN M (IBCLC, RN)
Entity type:Individual
Prefix:MRS
First Name:RAYANN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23103 LAWLESS RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-3562
Mailing Address - Country:US
Mailing Address - Phone:951-259-8177
Mailing Address - Fax:
Practice Address - Street 1:23103 LAWLESS RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-3562
Practice Address - Country:US
Practice Address - Phone:951-259-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL18437163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant