Doctor Name: | ALISSA DANIELLE SMITH |
NPI Number: | 1003046228 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 209007694 |
Business Practice Address: | 3132 Old Jacksonville Rd Suite 200 Springfield, IL - 627047400 |
Business Phone Number: | 2178620800 |
Business Fax Number: | |
Mailing Address: | Po Box 4566, SPRINGFIELD |
State: | IL |
Postal Code: | 627084566 |
Phone Number: | 8005775368 |
Fax Number: | 2177572021 |
NPI Enumeration Date: | 07/22/2009 |
NPI Last Update Date: | 08/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209007694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |