Individual
M'KENZEE B SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1100 E NORRIS DR, OTTAWA, IL 61350-1604
(815) 433-1010
Mailing address
1100 E NORRIS DR, OTTAWA, IL 61350-1604
(815) 433-1010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-014864
IL
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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