Individual
MARLA RAE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
869 NORTH ILLINOIS RT 3, WATERLOO, IL 62298
(618) 939-7771
(618) 939-7746
Mailing address
519 COVINGTON DRIVE, WATERLOO, IL 62298-3296
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
152008
MO
363LW0102X
Women's Health Nurse Practitioner
Primary
209007742
IL
Other
Enumeration date
12/20/2007
Last updated
09/09/2009
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