Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | IL 036-096070 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036-096070 | IL |
NPI | 1356567705 |
---|---|
Provider Name | Nora Majella Smith |
First Address | Riverside, IL 60546-2215 |
Second Address | Chicago, IL 60612-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G55043 | (02) | IL |