Individual
DIANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
209-005723
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-005723
LICENSE
IL
Enumeration date
12/21/2007
Last updated
09/17/2012
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