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Individual

AVERY SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1101 W PRATT BLVD APT 2W, CHICAGO, IL 60626-4477
(312) 953-0564
Mailing address
1101 W PRATT BLVD APT 2W, CHICAGO, IL 60626-4477
(312) 953-0564

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041400420
IL
163W00000X
Registered Nurse
25878830
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
209027680
IL

Other

Enumeration date
09/23/2021
Last updated
06/16/2023
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