Individual
GARRETT WILLIAM SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2808 EAST OUTER DR, MARION, IL 62959-5207
(618) 993-3817
(618) 993-3908
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209024498
IL
363LF0000X
Family Nurse Practitioner
30314
TN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/02/2021
Last updated
03/09/2022
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