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General NPI Number Information
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NPI Number | 1043171945
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Entity Type | Individual
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Provider Name | SELENA SMITH APRN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 473 W ARMY TRAIL RD STE 103
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2674
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Country | US
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Telephone | 630-529-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 261 CUNNINGHAM LN
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1915
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Country | US
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Telephone | 224-456-5470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209033994
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License Number State | IL
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