Individual
REBECCA LYNNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3880 SALEM LAKE DR # F, LONG GROVE, IL 60047
(847) 719-2220
(847) 719-2265
Mailing address
3880 SALEM LAKE DR # F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209013779
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209013779
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209013779
STATE LICENSE
IL
05
—
209013779
—
IL
Enumeration date
02/17/2016
Last updated
03/07/2023
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