Individual
JASON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
413 SANNER ST, EDWARDSVILLE, IL 62025-1080
(618) 203-3733
Mailing address
413 SANNER ST, EDWARDSVILLE, IL 62025-1080
(618) 203-3733
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APN.0993876-NP
CO
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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