MEDICARE: ELIZABETH D SMITH B.S.N., D.N.

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	163WH0200X	Home Health Registered Nurse	041-155827	IL
2	163WM1400X	Nurse Massage Therapist (NMT)	041-155827	IL
3	174400000X	Specialist	181-000233	IL

General Provider Information

NPI Number	:	1588784474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH D SMITH B.S.N., D.N.

Provider Business Mailing Address
First Line	:	4547 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3814
Country	:	US
Telephone Number	:	773-373-8994
Fax Number	:	773-373-8994

Provider Business Practice Location Address
First Line	:	4547 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3814
Country	:	US
Telephone Number	:	312-771-6112
Fax Number	:	773-373-8994

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	10/07/2009

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