Individual
LISA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
(618) 242-8240
Mailing address
1505 E MAIN ST, WEST FRANKFORT, IL 62896-1602
(727) 452-9033
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043074883
IL
Other
Enumeration date
02/06/2017
Last updated
12/08/2022
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