Individual
DOMINIQUE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
175 W JACKSON BLVD, 1750, CHICAGO, IL 60604-2615
(312) 548-2004
Mailing address
175 W JACKSON BLVD, 1750, CHICAGO, IL 60604-2615
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014603
IL
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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