MEDICARE: SARA E SMITH APN

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	363LW0102X	Women's Health Nurse Practitioner		IL

General Provider Information

NPI Number	:	1649471434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA E SMITH APN

Provider Business Mailing Address
First Line	:	3103 W KUNKLE BLVD
Second Line	:
City	:	FREEPORT
State	:	IL
Zip	:	61032-6922
Country	:	US
Telephone Number	:	815-233-0999
Fax Number	:	815-233-7255

Provider Business Practice Location Address
First Line	:	3103 W KUNKLE BLVD
Second Line	:
City	:	FREEPORT
State	:	IL
Zip	:	61032-6922
Country	:	US
Telephone Number	:	815-233-0999
Fax Number	:	815-233-7255

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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Directions to “ SARA E SMITH APN” Practice Location

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