Healthcare Provider Details

I. General information

NPI: 1710452065
Provider Name (Legal Business Name): SHERRYL FELICE SMITH-COLBERT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E 93RD ST
CHICAGO IL
60617-3909
US

IV. Provider business mailing address

25333 SHANNON DR
MANHATTAN IL
60442-6205
US

V. Phone/Fax

Practice location:
  • Phone: 773-967-2000
  • Fax:
Mailing address:
  • Phone: 815-260-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017920
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: