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General NPI Number Information
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NPI Number | 1841523776
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Entity Type | Organization
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Legal Business Name | WATERLOO WOMEN'S HEALTH
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 869 N. ILLINOIS RT 3
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City | WATERLOO
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State | IL
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Zip | 62298
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Country | US
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Telephone | 618-939-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 869 N. ILLINOIS RT 3
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City | WATERLOO
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State | IL
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Zip | 62298
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Country | US
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Telephone | 618-939-7771
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Fax |
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Authorized Official
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Title or Position | APN
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Name | MARLA R SMITH
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Credential | NP
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Telephone | 618-939-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209007742
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License Number State | IL
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