Doctor Name: | MRS. CRISTIE LYNN SMITH |
NPI Number: | 1235226069 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CERTIFIED MEDICAL AS |
License Number: | |
Business Practice Address: | 119 Gas Plant Rd Rea Clinic Du Quoin Du Quoin, IL - 62832 |
Business Phone Number: | 6187248702 |
Business Fax Number: | 6187242571 |
Mailing Address: | Po Box 155, Rea Clinic CHRISTOPHER |
State: | IL |
Postal Code: | 62832 |
Phone Number: | 6187242401 |
Fax Number: | 6187242571 |
NPI Enumeration Date: | 10/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |