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General NPI Number Information
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NPI Number | 1407953821
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Entity Type | Individual
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Provider Name | BRENDA KAY SMITH RN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 202 W PARK AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3929
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Country | US
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Telephone | 217-373-2436
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Fax | 217-373-2443
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Provider Business Mailing Address
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Address Line | 1820 SADLER DR
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5738
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Country | US
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Telephone | 217-373-2436
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Fax | 217-373-2443
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State | IL
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