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NPI Code Detail

MEDICARE: MS. CHRISTINE ANNE SMITH APN

MEDICARE: MS. CHRISTINE ANNE 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
1363LF0000XFamily Nurse Practitioner209001830IL

General Provider Information

NPI Number : 1740379676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE ANNE SMITH APN
Provider Business Mailing Address
First Line : 2315 WESLEY AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-2459
Country : US
Telephone Number : 708-749-2058
Fax Number : 773-921-2609
Provider Business Practice Location Address
First Line : 115 N PARKSIDE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60644-3040
Country : US
Telephone Number : 773-921-9669
Fax Number : 773-921-2609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 01/29/2009

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