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General NPI Number Information
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NPI Number | 1356139570
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Entity Type | Individual
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Provider Name | SAMANTHA JEAN SMITH RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 45 SOUTHLAND DR
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City | DECATUR
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State | IL
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Zip | 62521-4038
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Country | US
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Telephone | 217-620-8415
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 N EDWARD ST
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City | DECATUR
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State | IL
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Zip | 62526-4192
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Country | US
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Telephone | 217-876-3400
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Fax | 217-876-3408
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-87813
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 041320969
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License Number State | IL
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