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NPI Code Detail

MEDICARE: JONI D. SMITH CRNA

MEDICARE: JONI D. SMITH CRNA
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
1367500000XCertified Registered Nurse Anesthetist209003362IL
2367500000XCertified Registered Nurse Anesthetist209-003362IL

General Provider Information

NPI Number : 1417905308
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONI D. SMITH CRNA
Provider Business Mailing Address
First Line : 2202 HARLEM ROAD
Second Line :
City : LOVES PARK
State : IL
Zip : 61111-2754
Country : US
Telephone Number : 815-877-4848
Fax Number : 815-654-5342
Provider Business Practice Location Address
First Line : 2202 HARLEM ROAD
Second Line :
City : LOVES PARK
State : IL
Zip : 61111-2754
Country : US
Telephone Number : 815-877-4848
Fax Number : 815-654-5342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 12/08/2009

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