Individual
MANDA SHAE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11019908
FL
363LA2100X
Acute Care Nurse Practitioner
Primary
209019533
IL
363LF0000X
Family Nurse Practitioner
209019533
IL
Other
Enumeration date
06/20/2019
Last updated
08/25/2025
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