MEDICARE: KARLA J SMITH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209005721	IL

General Provider Information

NPI Number	:	1093730202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA J SMITH FNP

Provider Business Mailing Address
First Line	:	4630 W SCHUBERT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1841
Country	:	US
Telephone Number	:	773-495-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 W SCHUBERT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1841
Country	:	US
Telephone Number	:	773-495-5015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/27/2009

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