Individual
MR. MARK ZACHARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
605 S 19TH ST, HERRIN, IL 62948-2305
(618) 925-2866
Mailing address
605 S 19TH ST, HERRIN, IL 62948-2305
(618) 925-2866
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.105969
IL
Other
Enumeration date
01/14/2009
Last updated
01/14/2009
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