Individual
SANDRA SMITH-LEX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 EAST CARPENTER STREET, ROOM 2K64, SPRINGFIELD, IL 62769-0001
(217) 525-5643
(217) 544-2521
Mailing address
800 EAST CARPENTER STREET, ROOM 2K64, SPRINGFIELD, IL 62769-0001
(217) 525-5643
(217) 544-2521
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
041229268
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209001446
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031312
HEALTH ALLIANCE NUMBERS
IL
01
—
041229268
IL STATE LICENSE #
IL
01
—
209-005625
IL APN LICENSE #
IL
01
—
45622
AANA#
IL
Enumeration date
10/13/2005
Last updated
10/16/2013
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