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NPI Code Detail

MEDICARE: JANEKQUA ANAE SMITH-NICKSON

MEDICARE: JANEKQUA ANAE SMITH-NICKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse041565032IL

General Provider Information

NPI Number : 1194660035
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANEKQUA ANAE SMITH-NICKSON
Provider Business Mailing Address
First Line : 7208 S EVANS AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60619-1225
Country : US
Telephone Number : 312-446-5357
Fax Number :
Provider Business Practice Location Address
First Line : 2320 E 93RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-3909
Country : US
Telephone Number : 773-967-5436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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Directions to “ JANEKQUA ANAE SMITH-NICKSON ” Practice Location

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