Individual
MRS. LISA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
2905 N MAIN ST, DECATUR, IL 62526-4274
(217) 877-9117
(217) 877-3077
Mailing address
2905 N MAIN ST, DECATUR, IL 62526-4274
(217) 877-9117
(217) 877-3077
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209.004906
IL
Other
Enumeration date
02/22/2006
Last updated
03/13/2014
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