Individual
ASHLEIGH RENEE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
703 N 7TH ST, PETERSBURG, IL 62675-1144
(217) 719-1143
Mailing address
703 N 7TH ST, PETERSBURG, IL 62675-1144
(217) 719-1143
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
S530-0169-1829
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2019422646
—
IL
01
—
812189
DSCC
IL
Enumeration date
10/02/2015
Last updated
10/02/2015
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