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General NPI Number Information
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NPI Number | 1619610458
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Entity Type | Individual
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Provider Name | RYAN SMITH FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 1551 BOND ST STE 143
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City | NAPERVILLE
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State | IL
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Zip | 60563-0150
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Country | US
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Telephone | 150-584-7515
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Fax |
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Provider Business Mailing Address
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Address Line | 0S751 GRANT ST
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City | WINFIELD
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State | IL
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Zip | 60190-1535
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Country | US
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Telephone | 630-217-5838
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209025084
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License Number State | IL
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