Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 209.006805 | IL |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 71004643A | IN |
NPI | 1336329820 |
---|---|
Provider Name | Elizabeth Ellen Smith |
First Address | Mishawaka, IN 46545-1862 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28142802A | STATE OF INDIANA (01) | IN |
71004643A | STATE OF INDIANA (01) | IN |
71004643B | STATE OF IN (01) | IN |