Healthcare Provider Details

I. General information

NPI: 1346878451
Provider Name (Legal Business Name): ALLISON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KISH HOSPITAL DR
DEKALB IL
60115-9602
US

IV. Provider business mailing address

1128 S SCOVILLE AVE
OAK PARK IL
60304-2130
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-1521
  • Fax:
Mailing address:
  • Phone: 708-382-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209020959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: