Individual
CHELSEA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1340 CHARLES ST STE 300, ROCKFORD, IL 61104-2200
(779) 696-5888
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.018379
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400584619
MEDICARE PTAN
IL
Enumeration date
10/15/2018
Last updated
03/02/2021
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