Provider Demographics
NPI:1407553340
Name:SMITH, CAMILLE ALEXANDRIA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ALEXANDRIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2030
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2830
Mailing Address - Country:US
Mailing Address - Phone:312-926-6831
Mailing Address - Fax:312-926-2200
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2030
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2830
Practice Address - Country:US
Practice Address - Phone:312-926-6831
Practice Address - Fax:312-926-2200
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041471352163W00000X
IL209027409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse