MEDICARE: TERESA 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	363LF0000X	Family Nurse Practitioner	209-001464	IL

General Provider Information

NPI Number	:	1861499899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA SMITH APN

Provider Business Mailing Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1222
Country	:	US
Telephone Number	:	630-933-3503
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1222
Country	:	US
Telephone Number	:	630-933-3503
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	03/30/2017

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Directions to “ TERESA SMITH APN” Practice Location

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