MEDICARE: LONNETTA SMITH CNA

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	247200000X	Other Technician		IL

General Provider Information

NPI Number	:	1851024574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNETTA SMITH CNA

Provider Business Mailing Address
First Line	:	1316 W 112TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4404
Country	:	US
Telephone Number	:	717-668-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 W 112TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4404
Country	:	US
Telephone Number	:	717-668-4312
Fax Number	:

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

Provider Enumeration Date	:	07/09/2022
Last Update Date	:	07/09/2022

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Directions to “ LONNETTA SMITH CNA” Practice Location

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