Individual
ANNELISE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, CNM
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1200
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
209014861
IL
Other
Enumeration date
10/18/2016
Last updated
01/06/2022
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