Healthcare Provider Details

I. General information

NPI: 1346824620
Provider Name (Legal Business Name): RAHMANA AZIZ SMITH AGACNP-BC, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 S RIVER ROAD INC
DES PLAINES IL
60019-1443
US

IV. Provider business mailing address

9340 S MANISTEE AVE
CHICAGO IL
60617-4126
US

V. Phone/Fax

Practice location:
  • Phone: 224-803-2273
  • Fax: 224-803-2274
Mailing address:
  • Phone: 773-480-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041.360691
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041360691
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number209023475
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number209023475
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number209023475
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number209023475
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number209023475
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number209023475
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number209023475
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number209023475
License Number StateIL
# 11
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number209023475
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: